Active NPI
Debra J Thill, CPNP
- Pediatric Nurse Practitioner
- St Cloud, MN
National Provider Identifier
1407847551
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- R095701-4
- Practice address
- 1900 Centra Care Cir #1300
Centra Care Clinic Women'S & Children'S
St Cloud, MN 56303-5000 - Phone
- (320) 654-3610
- Fax
- (320) 654-3657
- NPI assigned
- Oct 28, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | R-095701-4 | MN | |
| Pediatric Nurse Practitioner | 363LP0200X | R095701-4 | MN | Primary |
Addresses
Primary practice location
1900 Centra Care Cir #1300
Centra Care Clinic Women'S & Children'S
St Cloud, MN 56303-5000
Mailing address
1900 Centra Care Cir #1300
Centra Care Clinic Women'S & Children'S
St Cloud, MN 56303-5000
Phone (320) 654-3610
Other identifiers 11
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 136613100 | Other | MEDICAL ASSISTANCE | |
| 06-28-04 | Other | CHAMPUS | |
| 267L3BE | Other | BLUE CROSS BLUE SHIELD | |
| HP31039 | Other | HEALTH PARTNERS | |
| 2172435 | Other | ARAZ GROUP AMERICAS PPO | |
| 7-22-04 | Other | MMSI | |
| 1025652 | Other | PREFERRED ONE | |
| 6-28-04 | Other | ONEHEALTH PLAN/GREAT WEST | |
| 1202912 | Other | MEDICA HEALTH PLANS | |
| 151365 | Other | U-CARE | |
| 6-28-04 | Other | FIRST HEALTH PLAN |
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)
- Enrolled
- Credentials
- Certified Pediatric Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R-095701-4 | MN | MD | Pediatric Nurse Practitioner |
| R095701-4 | MN | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Centracare Clinic | Past | Accepting new patients | |
| Wayzata Children'S Clinic P.a. | Past | Accepting new patients | |
| Centracare Clinic | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Multi-Specialty Clinic/Center
- St Joseph, MN
- NPI 1134121759
-
- Multi-Specialty Clinic/Center
- Saint Cloud, MN
- NPI 1225030844
-
- Pediatrics Physician
- Minnetonka, MN
- NPI 1023081577
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130457600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323302400000",
"number": "1407847551",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 CENTRA CARE CIR #1300",
"address_2": "CENTRA CARE CLINIC WOMEN'S & CHILDREN'S",
"city": "ST CLOUD",
"state": "MN",
"postal_code": "563035000",
"telephone_number": "320-654-3610",
"fax_number": "320-654-3657"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 CENTRA CARE CIR #1300",
"address_2": "CENTRA CARE CLINIC WOMEN'S & CHILDREN'S",
"city": "ST CLOUD",
"state": "MN",
"postal_code": "563035000",
"telephone_number": "320-654-3610",
"fax_number": "320-654-3657"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THILL",
"first_name": "DEBRA",
"middle_name": "J",
"credential": "CPNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-10-28",
"last_updated": "2011-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "MN",
"license": "R-095701-4",
"primary": false
},
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "MN",
"license": "R095701-4",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL ASSISTANCE",
"identifier": "136613100",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS",
"identifier": "06-28-04",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "267L3BE",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "HP31039",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ARAZ GROUP AMERICAS PPO",
"identifier": "2172435",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MMSI",
"identifier": "7-22-04",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "1025652",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ONEHEALTH PLAN/GREAT WEST",
"identifier": "6-28-04",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA HEALTH PLANS",
"identifier": "1202912",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "U-CARE",
"identifier": "151365",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST HEALTH PLAN",
"identifier": "6-28-04",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in St Cloud, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.