Mark L Thayer, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

32528 Issued in WI

Practice address

257 W Saint George Ave
Grantsburg, WI 54840-7827

Phone

(715) 463-5353

Fax

(715) 463-2753

NPI assigned

Apr 4, 2006

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN, WI2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mthayer641917@direct.ochin.org

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Burnett Medical Center Inc

  • Medicare Defined Swing Bed Hospital Unit
  • Grantsburg, WI
  • NPI 1003965435

  Corporate Director, W-2 Managing Employee

  CMS ownership
• Burnett Medical Center Inc

  • Critical Access Hospital
  • Grantsburg, WI
  • NPI 1225191687

  Corporate Director, W-2 Managing Employee

  CMS ownership
• Burnett Medical Center Inc

  dba Burnett Medical Center

  • Rural Health Clinic/Center
  • Grantsburg, WI
  • NPI 1356499784

  Corporate Director, W-2 Managing Employee

  CMS ownership
• Burnett Medical Center Inc

  • Skilled Nursing Facility
  • Grantsburg, WI
  • NPI 1487703815

  Adp of the SNF, Corporate Director, Trustee of the SNF

  CMS ownership

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.

• Burnett Medical Center Inc

  • Critical Access Hospital
  • Grantsburg, WI
  • NPI 1225191687
  Medicare reassignment NPD
• Burnett Medical Center Inc

  dba Burnett Medical Center

  • Rural Health Clinic/Center
  • Grantsburg, WI
  • NPI 1356499784
  Medicare reassignment NPD
• Allina Health System

  dba Allina Health Buffalo Specialty Clinic

  • Obstetrics & Gynecology Physician
  • Buffalo, MN
  • NPI 1295272342
  Medicare reassignment NPD
• Burnett Medical Center Inc

  • Skilled Nursing Facility
  • Grantsburg, WI
  • NPI 1487703815
  NPD
• Allina Health System

  dba Allina Health Faribault Clinic

  • Family Medicine Physician
  • Faribault, MN
  • NPI 1013213826
  NPD
• Allina Health System

  dba Allina Health TeleRheumatology

  • Rheumatology Physician
  • Coon Rapids, MN
  • NPI 1952146516
  NPD

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

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1568424778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "257 W SAINT GEORGE AVE",
            "city": "GRANTSBURG",
            "state": "WI",
            "postal_code": "548407827",
            "telephone_number": "715-463-5353",
            "fax_number": "715-463-2753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "257 W SAINT GEORGE AVE",
            "city": "GRANTSBURG",
            "state": "WI",
            "postal_code": "548407827",
            "telephone_number": "715-463-5353",
            "fax_number": "715-463-2753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THAYER",
        "first_name": "MARK",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-04",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "32528",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MN",
            "license": "31570",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WI",
            "license": "32528",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "918723500",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• St Croix Falls Eye Associates (Grantsburg Eye Associates)
• Nicholas John Stevens, PTA
• Jennifer Stolt, FNP-C
• Susan J Sup, DDS
• Anis Ben Tahar, R.PH
• Urology Associates, LTD.
• Abelardo Valdes, DDS
• Blaise Paul Vitale, M.D.
• Amy P Wachter, NP-F
• Christopher John Witzany, R. PH.

• Surgery Physician in Grantsburg, WI
• Providers in Grantsburg, WI by specialty
• Surgery Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.