Michele R. Thomazin, RN, FNP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

131629 Issued in MO

Practice address

1317 W Broadway St
Bolivar, MO 65613-1814

Phone

(417) 326-7250

Fax

(417) 326-2766

NPI assigned

Oct 13, 2006

Sex

Female

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

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Locations

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.

• Polk County Health Center

  • Public Health or Welfare Agency
  • Bolivar, MO
  • NPI 1265556849
  Medicare reassignment NPD

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441756800000",
    "number": "1528158474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1317 W BROADWAY ST",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656131814",
            "telephone_number": "417-326-7250",
            "fax_number": "417-326-2766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1317 W BROADWAY ST",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656131814",
            "telephone_number": "417-326-7250",
            "fax_number": "417-326-2766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMAZIN",
        "first_name": "MICHELE",
        "middle_name": "R.",
        "credential": "RN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-13",
        "last_updated": "2015-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "131629",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCMO",
            "identifier": "200905",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "427479100",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sylvia B McQueary, L.L.C.
• Michael W Taylor, MSW, LMSW
• Karen Testerman
• The Arc of the Ozarks
• The Arc of the Ozarks
• Deborah J Thompson, R.D., L.D.
• Grace Emily Tomlinson, LCSW
• Sandra Kay Tooley, PHARM D
• Trident Counseling Consulting & Wellness LLC
• Justine Erin Troske, MSOT, OTR/L

• Nurse Practitioner in Bolivar, MO
• Providers in Bolivar, MO by specialty
• Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2015; 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.