Individual provider Active NPI

Thirath Mark Luong, PA-C

  • Physician Assistant
  • Lakeville, MN
National Provider Identifier
1629304654
Registry record updated Oct 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10898 Issued in MN
Practice address
17210 Kenyon Ave
Lakeville, MN 55044-6903
Phone
(651) 968-5201
Fax
(651) 968-5903
NPI assigned
Oct 27, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 10898 MN Primary

Addresses

Primary practice location

17210 Kenyon Ave
Lakeville, MN 55044-6903

Mailing address

710 Commerce Dr Ste 200
Woodbury, MN 55125-4925
Phone (651) 968-5200

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110915000624 MN Practitioner - Physician Assistant 3870620842 Reassigns benefits to 1 organization
I20210622003723 WI Practitioner - Physician Assistant 3870620842 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Philadelphia College of Osteopathic Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Orthopedics, LTDGroup PAC ID 8921900374, 282 clinicians

Practice addresses (Care Compare)

1661 Saint Anthony Ave
Saint Paul, MN 55104-3733
Phone (651) 968-5201

2090 Woodwinds Dr
Saint Paul, MN 55125-2522
Phone (651) 968-5201

3580 Arcade St
Vadnais Heights, MN 55127-7135
Phone (651) 968-5201

6050 Sycamore LN N
Plymouth, MN 55442-1402
Phone (651) 968-5201

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Orthopedics, LTD. CurrentSince Jul 13, 2011 Accepting new patients
Summit Orthopedics LTD CurrentSince Jul 13, 2011 Accepting new patients
Summit Orthopedics LTD Current Accepting new patients
Summit Orthopedics, LTD CurrentSince Jun 1, 2021 Accepting new patients
Immediate Medical Care of Pennsylvania, LP PastSince Jun 1, 2008 Accepting new patients

Locations

2620 Eagan Woods Dr
Ste 100
Eagan, MN 55121
Phone (651) 968-5230

17210 Kenyon Ave
Lakeville, MN 55044
Phone (651) 968-5960

1661 Saint Anthony Ave
Saint Paul, MN 55104
Phone (651) 968-5300

2620 Eagan Woods Dr
Saint Paul, MN 55121
Phone (651) 968-5142

3580 Arcade St
Vadnais Heights, MN 55127
Phone (651) 968-5600

3580 Arcade St
Ste 100
Vadnais Heights, MN 55127

2090 Woodwinds Dr
Woodbury, MN 55125
Phone (651) 968-5801

710 Commerce Dr
Ste 200
Woodbury, MN 55125
Phone (651) 968-5042

319 S Main St
River Falls, WI 54022
Phone (715) 425-6701

Interoperability endpoints

  • Direct secure messaging: thirathluong@sol.allscriptsdirect.net

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1256601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761868800000",
    "number": "1629304654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 COMMERCE DR STE 200",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551254925",
            "telephone_number": "651-968-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17210 KENYON AVE",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550446903",
            "telephone_number": "651-968-5201",
            "fax_number": "651-968-5903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUONG",
        "first_name": "THIRATH",
        "middle_name": "MARK",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-10-27",
        "last_updated": "2025-10-31",
        "certification_date": "2025-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "10898",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeville, MN

Sources for this page

Verify at the official NPI Registry.