NPIMap

Individual provider Active NPI

Thomas Christopher Kowalkowski, D.O.

  • Interventional Pain Medicine Physician
  • Sartell, MN
National Provider Identifier
1477569606
Registry record updated Mar 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
41961 Issued in MN
Practice address
2301 Connecticut Avenue South
Sartell, MN 56377-2474
Phone
(320) 229-1500
Fax
(320) 229-1505
NPI assigned
Jul 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine Physician 208VP0014X 41961 MN Primary

Addresses

Primary practice location

2301 Connecticut Avenue South
Sartell, MN 56377-2474

Mailing address

2301 Connecticut Avenue South
Sartell, MN 56377-2474
Phone (320) 229-1500

Other identifiers 1

IdentifierTypeStateIssuer
410645800MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040224000103 MN Practitioner - Physical Medicine and RehabilitationPractitioner - Pain Management 1951297449 Reassigns benefits to 1 organization
I20241003001789 WI Practitioner - Pain ManagementPractitioner - Interventional Pain Management 1951297449

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and RehabilitationAlso: Pain Management
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Interventional Pain and Physical Medicine ClinicGroup PAC ID 3375439953, 2 clinicians

Practice addresses (Care Compare)

2301 Connecticut Ave S
Sartell, MN 56377-2474
Phone 3202291500108

Hospital & facility affiliations

  • Abbott Northwestern Hospital Hospital, Minneapolis, MN, CCN 240057

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Interventional Pain & Physical Medicine Clinic Interventional Pain Medicine CurrentSince Feb 1, 2004 Accepting new patients
Interventional Pain & Physical Medicine Clinic CurrentSince Jan 1, 2004 Accepting new patients
Interventional Pain & Physical Medicine Clinic Past Accepting new patients
Interventional Pain & Physical Medicine Clinic Past Accepting new patients

Locations

2301 Connecticut Ave S
Sartell, MN 56377
Phone (320) 229-1500

Interoperability endpoints

  • Direct secure messaging: tkowalkowski239408@direct.aspirus.org
  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 4

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.

Hospital & facility affiliations 23

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 23

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332720000000",
    "number": "1477569606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 CONNECTICUT AVENUE SOUTH",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563772474",
            "telephone_number": "320-229-1500",
            "fax_number": "320-229-1505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 CONNECTICUT AVENUE SOUTH",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563772474",
            "telephone_number": "320-229-1500",
            "fax_number": "320-229-1505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOWALKOWSKI",
        "first_name": "THOMAS",
        "middle_name": "CHRISTOPHER",
        "name_prefix": "Mr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2012-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "MN",
            "license": "41961",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "410645800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sartell, MN

Sources for this page

Verify at the official NPI Registry.