NPIMap

Organization Active NPI

Our Lady of Peace

Doing business as Our Lady of Peace Palliative Care

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Saint Paul, MN
National Provider Identifier
1629857222
Registry record updated Sep 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Internal Medicine) PhysicianTaxonomy code 207RH0002X
Legal business name
OUR LADY OF PEACE
Doing business as
Our Lady of Peace Palliative Care
Practice address
2076 Saint Anthony Ave
Saint Paul, MN 55104-4543
Phone
(651) 789-5031
Fax
(651) 789-0078
NPI assigned
Sep 25, 2023
Last updated
Sep 25, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
OUR LADY OF PEACEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 25, 2023

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

Authorized official

Name
Jeffrey Thorne
Title
Ceo
Phone
(651) 789-5031

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Internal Medicine) Physician 207RH0002X Primary

Addresses

Primary practice location

2076 Saint Anthony Ave
Saint Paul, MN 55104-4543

Mailing address

2076 Saint Anthony Ave
Saint Paul, MN 55104-4543
Phone (651) 789-5031

Other names 1

  • Our Lady of Peace Palliative Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220714001764 MN Part B Supplier - Clinic/Group Practice 7911892211 Receives reassigned benefits from 1 practitioner
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Saint Paul, MN

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Our Lady of Peace5 organizations share this tax ID, including this one
Part of
Our Lady of Peace

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1695600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695600000000",
    "number": "1629857222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2076 SAINT ANTHONY AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551044543",
            "telephone_number": "651-789-5031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2076 SAINT ANTHONY AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551044543",
            "telephone_number": "651-789-5031",
            "fax_number": "651-789-0078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUR LADY OF PEACE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OUR LADY OF PEACE",
        "enumeration_date": "2023-09-25",
        "last_updated": "2023-09-25",
        "certification_date": "2023-01-25",
        "status": "A",
        "authorized_official_last_name": "THORNE",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "651-789-5031"
    },
    "taxonomies": [
        {
            "code": "207RH0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Our Lady of Peace Palliative Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.