NPIMap

Individual provider Active NPI

Thom G. a. Dahle, MD

  • Interventional Cardiology Physician
  • Saint Cloud, MN
National Provider Identifier
1760458673
Registry record updated Sep 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
46342 Issued in 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
Last updated
Sep 12, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2024

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

Specialties & licenses 2

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

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

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

Care Compare profile

Medicare Care Compare
Specialty
Interventional CardiologyAlso: Cardiovascular Disease (Cardiology)
Education
University of Minnesota Medical School, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians
Astera HealthGroup PAC ID 2961395272, shared by 8 NPIs, 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

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting39

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
46342MNMDInterventional Cardiology Physician

Practice roles

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

Locations

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

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

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

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

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

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

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

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

921 Greeley St S
Stillwater, MN 55082

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

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

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

Interoperability endpoints

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

Organizations & group practices 17

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.

View all 17

Hospital & facility affiliations 12

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

NPI Registry JSON

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

{
    "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": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.