Individual provider Active NPI

Cassidy Renee Thomas, PA-C

  • Surgical Physician Assistant
  • Denver, CO
National Provider Identifier
1821612045
Registry record updated Jun 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA.0007319 Issued in CO
Practice address
777 Bannock St
Denver, CO 80204-4597
Phone
(303) 436-6000
NPI assigned
Jun 3, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X
Surgical Physician Assistant 363AS0400X PA.0007319 CO Primary

Addresses

Primary practice location

777 Bannock St
Denver, CO 80204-4597

Mailing address

1141 N Emerson St Apt 4
Denver, CO 80218-2972
Phone (906) 360-6363

Other practice location 1

1111 Delafield St Ste 209
Waukesha, WI 53188-3403
Phone (262) 542-0444

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230516000483 MI Practitioner - Physician Assistant 5092131003 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1414 W Fair Ave
Marquette, MI 49855-2675

850 W Baraga Ave
Marquette, MI 49855-4550

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PA.0007319COMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
DLP Marquette Physician Practices Inc CurrentSince Jul 1, 2023 Accepting new patients
DLP Marquette Physician Practices Inc CurrentSince Jul 1, 2023 Accepting new patients
DLP Marquette Physician Practices Inc Past Accepting new patients

Locations

1414 W Fair Ave
Ste 211
Marquette, MI 49855
Phone (906) 225-3912

1414 W Fair Ave
Ste 36
Marquette, MI 49855
Phone (906) 225-3864

330 Seven Springs Way
Brentwood, TN 37027
Phone (615) 920-7780

Interoperability endpoints

  • Direct secure messaging: cassidy.thomas.1@8233.direct.athenahealth.com

Organizations & group practices 3

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.

Hospital & facility affiliations 5

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": "1591142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655856000000",
    "number": "1821612045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1141 N EMERSON ST APT 4",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802182972",
            "telephone_number": "906-360-6363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 BANNOCK ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802044597",
            "telephone_number": "303-436-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1111 Delafield St Ste 209",
            "address_purpose": "LOCATION",
            "city": "Waukesha",
            "state": "WI",
            "postal_code": "531883403",
            "country_code": "US",
            "telephone_number": "262-542-0444",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "CASSIDY",
        "middle_name": "RENEE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-03",
        "last_updated": "2022-06-22",
        "certification_date": "2022-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CO",
            "license": "PA.0007319",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Denver, CO

Sources for this page

Verify at the official NPI Registry.