NPIMap

Thom G. a. Dahle, MD

Individual provider Active NPI Interventional Cardiology Physician · Saint Cloud, MN

NPI 1760458673 · NPPES record last updated Sep 12, 2024

Key facts

NPI
1760458673
Entity type
Individual (NPI type 1)
Primary specialty
Interventional Cardiology Physician 207RI0011X
License
46342 (MN)
Practice address
1200 6TH Ave N
Centracare Clinic
Saint Cloud, MN 56303-2735
Phone
(320) 252-5131
Fax
(320) 255-5714
NPI assigned
Feb 28, 2006
Sex
Male
Sole proprietor
No

Organizations & group practices 35

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.

View all 35

Hospital & facility affiliations 12

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

Medicare Care Compare profile

Specialty
Interventional Cardiology
Also: Cardiovascular Disease (Cardiology)
Education
University of Minnesota Medical School, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centracare Clinic (800 clinicians)
Astera Health (106 clinicians)

Practice addresses (Care Compare)

101 Willmar Ave SW
Willmar, MN 56201-3556
Phone (320) 231-5000

1200 6TH Ave N
Saint Cloud, MN 56303-2735

1200 6TH N Ave
Saint Cloud, MN 56303-2735
Phone (320) 252-5131

1406 6TH Ave N
St Cloud, MN 56303-1901

1406 6TH Ave No
St Cloud, MN 56303-1901

1900 Centracare Cir
Saint Cloud, MN 56303-5000

4 Deerwood Ave NW
Wadena, MN 56482-1253
Phone (218) 631-1360

415 Jefferson St N
Wadena, MN 56482-1264
Phone (218) 631-7495

415 Jefferson St N
Wadena, MN 56482-1296

7418 Forthun Rd
Baxter, MN 56425-8702
Phone (218) 297-2048

PO Box
Chicago, IL 60673

Hospital & facility affiliations

  • Centracare - St. Cloud Hospital Hospital · Saint Cloud, MN · CCN 240036
  • Alomere Health Hospital · Alexandria, MN · CCN 240030
  • Centracare- Rice Memorial Hospital Hospital · Willmar, MN · CCN 240088
  • Glacial Ridge Hospital Hospital · Glenwood, MN · CCN 241376
  • Centracare Health - Monticello Hospital · Monticello, MN · CCN 241362

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting39

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20040318001068 MN Practitioner - Interventional Cardiology
Practitioner - Cardiovascular Disease (Cardiology)
Practitioner - Internal Medicine		 4688564081 Reassigns benefits to 8 organizations

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
46342MNMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mille Lacs Health System Current Accepting new patients
Mille Lacs Health System Current
since Jan 1, 2024		 Accepting new patients
Astera Health Current
since Jan 1, 2020		 Accepting new patients
Group Health, Inc. Current
since Sep 1, 2010		 Accepting new patients
Astera Health Current Accepting new patients
Mille Lacs Health System Current
since Jan 4, 2026		 Accepting new patients
Mille Lacs Health System Current
since Jan 1, 2024		 Accepting new patients
Mille Lacs Health System Current Accepting new patients
Centracare Clinic Current
since Feb 1, 2013		 Accepting new patients
Astera Health Current
since Jan 1, 2020		 Accepting new patients
Group Health Plan, Inc. Current
since Sep 1, 2010		 Accepting new patients
Centracare Health System-NR LLC Current
since Sep 1, 2019		 Accepting new patients
Centracare Health System-NR LLC Current
since Sep 1, 2019		 Accepting new patients
Centracare Clinic Current Accepting new patients
Group Health, Inc. Current Accepting new patients
Centracare Health System-NR LLC Current Accepting new patients
St. Cloud Hospital Past Accepting new patients
Centracare Clinic Past Accepting new patients
Centracare Clinic Past Accepting new patients

Locations

523 N 3rd St
Brainerd, MN 56401
Phone (218) 828-7394

2024 S 6th St
Brainerd, MN 56401
Phone (218) 828-2880

201 E Nicollet Blvd
Burnsville, MN 55337
Phone (952) 892-2000

27378 State Highway 18
Garrison, MN 56450
Phone (320) 692-5599

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

6401 France Ave S
Minneapolis, MN 55435
Phone (952) 920-8477

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

1013 Hart Blvd
Monticello, MN 55362
Phone (763) 271-2303

200 Elm St N
Onamia, MN 56359
Phone (320) 532-2750

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

640 Jackson St
Saint Paul, MN 55101
Phone (651) 221-2164

1500 Curve Crest Blvd W
Stillwater, MN 55082

415 Jefferson St N
Wadena, MN 56482
Phone (218) 631-3510

4 Deerwood Ave NW
Wadena, MN 56482
Phone (218) 631-1100

921 Greeley St S
West Lakeland, MN 55082

301 Becker Ave SW
Willmar, MN 56201
Phone (320) 231-4120

Interoperability endpoints

  • Direct secure messaging: tdahle41919@direct.centracare.com

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 46342 MN
Interventional Cardiology Physician 207RI0011X 46342 MN Yes

Addresses

Primary practice location

1200 6TH Ave N
Centracare Clinic
Saint Cloud, MN 56303-2735

Mailing address

1200 6TH Ave N
Centracare Clinic
Saint Cloud, MN 56303-2735
Phone (320) 252-5131

Other identifiers

IdentifierTypeStateIssuer
869632200MedicaidMN

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 12, 2024.

{
    "created_epoch": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726099200000",
    "number": "1760458673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 6TH AVE N",
            "address_2": "CENTRACARE CLINIC",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032735",
            "telephone_number": "320-252-5131",
            "fax_number": "952-883-5395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 6TH AVE N",
            "address_2": "CENTRACARE CLINIC",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032735",
            "telephone_number": "320-252-5131",
            "fax_number": "320-255-5714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAHLE",
        "first_name": "THOM",
        "middle_name": "G. A.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-28",
        "last_updated": "2024-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "46342",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "MN",
            "license": "46342",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "869632200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

All providers in Saint Cloud, MN · Interventional Cardiology Physician in Minnesota

Sources for this page

Verify at the official NPI Registry.