Active NPI
Corey Thompson, PA-C
- Physician Assistant
- Waltham, MN
National Provider Identifier
1386228583
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 13635
- Practice address
- 33528 600TH Ave
Waltham, MN 55982-7681 - Phone
- (507) 279-2510
- NPI assigned
- May 12, 2021
- Last updated
- May 12, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 13635 | MN | Primary |
Addresses
Primary practice location
33528 600TH Ave
Waltham, MN 55982-7681
Mailing address
33528 600TH Ave
Waltham, MN 55982-7681
Phone (507) 279-2510
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13635 | MN | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1620777600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620777600000",
"number": "1386228583",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33528 600TH AVE",
"city": "WALTHAM",
"state": "MN",
"postal_code": "559827681",
"telephone_number": "507-279-2510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "33528 600TH AVE",
"city": "WALTHAM",
"state": "MN",
"postal_code": "559827681",
"telephone_number": "507-279-2510"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THOMPSON",
"first_name": "COREY",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-05-12",
"last_updated": "2021-05-12",
"certification_date": "2021-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MN",
"license": "13635",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.