Andrea K Thelen, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA2010-0024 Issued in NM

Practice address

5150 Journal Center Blvd NE
Albuquerque, NM 87109

Phone

(505) 262-3233

NPI assigned

Apr 12, 2010

Last updated

Mar 16, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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 NM, TX, MI3 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 3

Specialty

Physician Assistant

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ecs Western Michigan PCGroup PAC ID 8628327384, 202 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Corewell Health Pennock Hospital Hospital, Hastings, MI, CCN 231339

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ecs Western Michigan PC

  • Emergency Medicine Physician
  • Grand Rapids, MI
  • NPI 1992281000
  Medicare reassignment Care Compare group
• Manzano Medical Group, P.C.

  • Physical Medicine & Rehabilitation Physician
  • Albuquerque, NM
  • NPI 1881704096
  Medicare reassignment
• C,L and W PLLC

  dba Affordacare

  • Urgent Care Clinic/Center
  • Abilene, TX
  • NPI 1619235629
  Medicare reassignment
• Sparrow Ionia Hospital

  dba University of Michigan Health-Sparrow Ionia

  • Critical Access Hospital
  • Ionia, MI
  • NPI 1700820065
  Medicare reassignment
• Sparrow Ionia Hospital

  dba Sparrow Medical Group Ionia

  • Family Medicine Physician
  • Ionia, MI
  • NPI 1033271143
  NPD
• Sparrow Ionia Hospital

  dba Sparrow Ionia Hospital Crna Services

  • Certified Registered Nurse Anesthetist
  • Ionia, MI
  • NPI 1710900659
  NPD
• Optumcare Endoscopy Center New Mexico, LLC

  dba DaVita Medical Endoscopy

  • Ambulatory Surgical Clinic/Center
  • Albuquerque, NM
  • NPI 1962685834
  NPD (past)
• Lansing Urgent Care, PLC

  • Urgent Care Clinic/Center
  • Lansing, MI
  • NPI 1780987990
  NPD (past)

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

• Pennock Hospital

  dba Corewell Health Pennock Hospital

  • Critical Access Hospital
  • Hastings, MI
  • NPI 1932695525
  Care Compare affiliation

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

{
    "created_epoch": "1271030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584316800000",
    "number": "1629394945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26028",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871256028",
            "telephone_number": "505-262-3135",
            "fax_number": "505-232-1627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5150 JOURNAL CENTER BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "87109",
            "telephone_number": "505-262-3233"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "104 MEDICAL DRIVE",
            "address_purpose": "LOCATION",
            "city": "OZONA",
            "state": "TX",
            "postal_code": "76943",
            "country_code": "US",
            "telephone_number": "325-792-3866",
            "fax_number": "325-481-2166",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THELEN",
        "first_name": "ANDREA",
        "middle_name": "K",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-04-12",
        "last_updated": "2020-03-16",
        "certification_date": "2020-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NM",
            "license": "PA2010-0024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PA08598",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31602843",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• The Well Collective, LLC
• The Willow Tree Center for Counseling, Psychotherapy, and Clinical Hyp
• The Woodmark at Uptown
• Gladys Theiler
• Meghan Louise Theiss, MA, LMHC
• Sereena Rae Thelen, M.S. CCC-SLP
• Tara Kathryn Thelen, LMHC
• Themis Training and Consulting LLC (Thunderbird Rising Recovery)
• Theodore L Varoz DPM
• Kai Marie Theophilus, LMT

• Physician Assistant in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Physician Assistant in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2020; 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.