Mark J Thibault, MD

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

32514 Issued in MN

Practice address

1901 Connecticut Ave S
Sartell, MN 56377-2554

Phone

(320) 259-4100

Fax

(320) 257-5523

NPI assigned

Jul 11, 2006

Sex

Male

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 1

Medicare fee-for-service enrollment

Enrolled in MN

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 1

Specialty

Physical Medicine and Rehabilitation

Education

University of Minnesota Medical School, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Interventional Spine and Pain Physicians PAGroup PAC ID 2466606264, 42 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

82.31 of 100Reported as group

Quality

74.55

Promoting interoperability

79

Improvement activities

40

Cost

83.98

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mthibault@stcloudortho1831.srs-direct.com

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.

• Interventional Spine and Pain Physicians, PA

  • Specialist
  • Maple Grove, MN
  • NPI 1326398561

  Physical Medicine & Rehabilitation

  Medicare reassignment Care Compare group NPD
• Physicians' Diagnostics & Rehabilitation,LTD

  • Physical Medicine & Rehabilitation Physician
  • Edina, MN
  • NPI 1073626081
  NPD (past)

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614124800000",
    "number": "1679507776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 CONNECTICUT AVE S",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563772554",
            "telephone_number": "320-259-4100",
            "fax_number": "320-257-5523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 CONNECTICUT AVE S",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563772554",
            "telephone_number": "320-259-4100",
            "fax_number": "320-257-5523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIBAULT",
        "first_name": "MARK",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2021-02-24",
        "certification_date": "2021-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MN",
            "license": "32514",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "243877100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• The Foundation for Health Care Continuums
• The Foundation for Health Care Continuums
• The Foundation for Health Care Continuums
• The Foundation for Health Care Continuums
• Staci M Theisen, ATC
• Shari Anne Thom, DDS
• Catherine Gail Thompson
• Kathryn Elizabeth Thompson, DDS
• Madeleine Constance Mary Thompson
• Suzanne E Thompson, M.S.

• Physical Medicine & Rehabilitation Physician in Sartell, MN
• Providers in Sartell, MN by specialty
• Physical Medicine & Rehabilitation Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2021; 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.