NPIMap

Individual provider Active NPI

Thomas Edwin Nielsen, M.D.

  • Phlebology Physician
  • Bloomington, IL
National Provider Identifier
1871521757
Registry record updated Mar 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Phlebology PhysicianTaxonomy code 202K00000X
License
036065215 Issued in IL
Practice address
3302 Gerig Dr
Suite 100
Bloomington, IL 61704-6365
Phone
(309) 862-4000
Fax
(309) 862-4055
NPI assigned
Jun 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Phlebology Physician 202K00000X 036065215 IL Primary

Addresses

Primary practice location

3302 Gerig Dr
Suite 100
Bloomington, IL 61704-6365

Mailing address

3302 Gerig Dr
Suite 100
Bloomington, IL 61704-6365
Phone (309) 862-4000

Other identifiers 1

IdentifierTypeStateIssuer
05721369OtherILBC/BS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20040520000197 IL Practitioner - Family PracticePractitioner - Emergency Medicine 3779574603 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine
Education
Southern Illinois University School of Medicine, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Vein Specialists, LLCGroup PAC ID 3870782915, 5 clinicians

Practice addresses (Care Compare)

3302 Gerig Dr
Suite 100
Bloomington, IL 61704-6343
Phone (309) 862-4000

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal157

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036065215ILMDPhlebology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dermatology and Skin Cancer Center CurrentSince Oct 15, 2023 Accepting new patients
The Vein Specialists, LLC CurrentSince May 1, 2011 Accepting new patients
Crossroads Emergency Physicians, LLP Past Accepting new patients
Heartland Emergency Specialists, LLC Past Accepting new patients
Eastern Illinois Emergency Physicians, LLP PastSince Jul 9, 2004 Accepting new patients
Prairie Emergency Group, LTD. Past Accepting new patients
Bestpractices of Illinois PC Past Accepting new patients
Illiana Emergency Physicians LLP Past Accepting new patients
Central Illinois Neuroradiology, LTD Past Accepting new patients

Locations

3302 Gerig Dr
Ste 100
Bloomington, IL 61704
Phone (309) 533-7070

Interoperability endpoints

  • Direct secure messaging: thomas.nielsen.1@21322.direct.athenahealth.com

Organizations & group practices 9

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": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395705600000",
    "number": "1871521757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3302 GERIG DR",
            "address_2": "SUITE 100",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617046365",
            "telephone_number": "309-862-4000",
            "fax_number": "309-862-4055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3302 GERIG DR",
            "address_2": "SUITE 100",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617046365",
            "telephone_number": "309-862-4000",
            "fax_number": "309-862-4055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIELSEN",
        "first_name": "THOMAS",
        "middle_name": "EDWIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-29",
        "last_updated": "2014-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "202K00000X",
            "taxonomy_group": "",
            "desc": "Phlebology",
            "state": "IL",
            "license": "036065215",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "05721369",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IL

Sources for this page

Verify at the official NPI Registry.