Individual provider Active NPI

Bradley Robert Thomsen, D.C.

  • Chiropractor
  • Grand Forks, ND
National Provider Identifier
1801888342
Registry record updated May 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
649 Issued in ND
Practice address
2534 17TH Ave S
Suite 2D
Grand Forks, ND 58201-5215
Phone
(701) 746-8636
Fax
(701) 746-8827
NPI assigned
Aug 19, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 649 ND Primary

Addresses

Primary practice location

2534 17TH Ave S
Suite 2D
Grand Forks, ND 58201-5215

Mailing address

PO Box 12875
Grand Forks, ND 58208-2875
Phone (701) 746-8636

Other identifiers 1

IdentifierTypeStateIssuer
10583MedicaidND

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090529000486 ND Practitioner - Chiropractic 9830248434 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2534 17TH Ave S
Suite D2
Grand Forks, ND 58201-5215
Phone (701) 746-8636

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Red River Family Chiropractic, PC Chiropractor CurrentSince Apr 27, 2009 Accepting new patients

Locations

1815 Demers Ave
Grand Forks, ND 58201
Phone (201) 746-8636

2534 17th Ave S
Ste D2
Grand Forks, ND 58201
Phone (701) 746-8636

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1124409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431475200000",
    "number": "1801888342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12875",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582082875",
            "telephone_number": "701-746-8636",
            "fax_number": "701-746-8827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2534 17TH AVE S",
            "address_2": "SUITE 2D",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582015215",
            "telephone_number": "701-746-8636",
            "fax_number": "701-746-8827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMSEN",
        "first_name": "BRADLEY",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-19",
        "last_updated": "2015-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "ND",
            "license": "649",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10583",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Forks, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.