Thammasak Mingbunjerdsuk

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

MD61202611 Issued in WA

Practice address

1615 Delaware St
Longview, WA 98632-2367

Phone

(360) 414-2000

Fax

(360) 414-7638

NPI assigned

Jun 23, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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

Gastroenterology

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

PeacehealthGroup PAC ID 5890689293, 188 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Peacehealth St John Medical Center Hospital, Longview, WA, CCN 500041

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tmingbunjerdsuk559350@direct.peacehealth.org
• Direct secure messaging: tmingbunjerdsuk22684@ukhcdirect.org

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.

• Peacehealth

  • Multi-Specialty Clinic/Center
  • Longview, WA
  • NPI 1720056187

  Gastroenterology

  Medicare reassignment Care Compare group NPD
• Peacehealth

  • Physical Therapist
  • Longview, WA
  • NPI 1275501538
  NPD (past)

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

• Peacehealth

  • General Acute Care Hospital
  • Longview, WA
  • NPI 1073510277
  Care Compare affiliation

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

{
    "created_epoch": "1466640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651017600000",
    "number": "1720439490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "223 INDIANA AVE APT 3211",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794155369",
            "telephone_number": "916-436-6401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 DELAWARE ST",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322367",
            "telephone_number": "360-414-2000",
            "fax_number": "360-414-7638"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3601 4th St",
            "address_purpose": "LOCATION",
            "city": "Lubbock",
            "state": "TX",
            "postal_code": "794300002",
            "country_code": "US",
            "telephone_number": "916-436-6401",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MINGBUNJERDSUK",
        "first_name": "THAMMASAK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-23",
        "last_updated": "2022-04-27",
        "certification_date": "2022-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "WA",
            "license": "MD61202611",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Elizabeth Miller
• Monica Miller, RD, LD, CDE
• Roxanne Lee Miller
• Crystal Millien
• Kimberly Milne, DDS
• Minhhuy Nguyen, PLLC
• Alexis Rea Minium, LMP
• Megan Minthorn, RN
• Mason Minton, LMP
• Diane Michelle Miollis, LMP

• Gastroenterology Physician in Longview, WA
• Providers in Longview, WA by specialty
• Gastroenterology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2022; 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.