Mark David Thieberg, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

J7227 Issued in TX

Practice address

4708 Alliance Blvd Ste 300
Baylor Medical Plaza 1
Plano, TX 75093-5339

Phone

(972) 758-6000

Fax

(972) 758-6001

NPI assigned

Aug 21, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Icahn School of Medicine at Mount Sinai, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Healthtexas Provider NetworkGroup PAC ID 1355254210, 2,535 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mthieberg222495@direct.sw.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Healthtexas Provider Network

  • Family Medicine Physician
  • Dallas, TX
  • NPI 1760488936

  Dermatology

  Medicare reassignment Care Compare group NPD
• Healthtexas Provider Network

  dba Symmetry Anesthesia

  • Anesthesiology Physician
  • Lakeway, TX
  • NPI 1104714583
  NPD
• Healthtexas Provider Network

  • Family Medicine Physician
  • Flower Mound, TX
  • NPI 1427054402
  NPD
• Healthtexas Provider Network--Dallas Diagnostic Association

  • Dermatology Physician
  • Garland, TX
  • NPI 1255337275
  NPD
• Healthtexas-Dallas Diagnostic Association

  dba Dallas Diagnostic Association

  • Internal Medicine Physician
  • Plano, TX
  • NPI 1245235886

  Dermatology

  NPD
• Healthtexas Provider Network

  • Family Medicine Physician
  • Plano, TX
  • NPI 1003811639
  NPD (past)

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671062400000",
    "number": "1477669992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4708 ALLIANCE BLVD STE 300",
            "address_2": "BAYLOR MEDICAL PLAZA 1",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750935339",
            "telephone_number": "972-758-6000",
            "fax_number": "972-758-6001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4708 ALLIANCE BLVD STE 300",
            "address_2": "BAYLOR MEDICAL PLAZA 1",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750935339",
            "telephone_number": "972-758-6000",
            "fax_number": "972-758-6001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIEBERG",
        "first_name": "MARK",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-21",
        "last_updated": "2022-12-15",
        "certification_date": "2022-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TX",
            "license": "J7227",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "83X005",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104001602",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mthieberg222495@direct.sw.org",
            "affiliation": "N",
            "address_1": "4716 Alliance Blvd Ste 750",
            "city": "Plano",
            "state": "TX",
            "country_code": "US",
            "postal_code": "750935390",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Dermatology Physician in Plano, TX
• Providers in Plano, TX by specialty
• Dermatology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.