Individual provider Active NPI

Mark Wilson Thomas, DO

  • Anesthesiology Physician
  • Provo, UT
National Provider Identifier
1881954634
Registry record updated Jan 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
12106328-1204 Issued in UT
Practice address
1034 N 500 W
Provo, UT 84604
Phone
(208) 360-3560
NPI assigned
May 25, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MED-PHYS-LIC-47547 MT
Anesthesiology Physician 207L00000X 02004574A IN
Anesthesiology Physician 207L00000X DO222639 OR
Anesthesiology Physician 207L00000X 12106328-1204 UT Primary

Addresses

Primary practice location

1034 N 500 W
Provo, UT 84604

Mailing address

334 W 800 S
Salem, UT 84653-5611
Phone (208) 360-3560

Other practice location 1

1130 W Michigan St
Indianapolis, IN 46202-5209
Phone (317) 274-0275

Other practice location 2

765 E Market Place Dr
Spanish Fork, UT 84660
Phone (208) 360-3560

Other practice location 3

2800 10th Ave N
Billings, MT 59101
Phone (406) 238-2500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, OR2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210416001254 UT Practitioner - Anesthesiology 3274768007 Reassigns benefits to 1 organization
I20250121003312 OR Practitioner - Anesthesiology 3274768007 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Arizona College of Osteopathic Medicine Mid Western University, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountain West Anesthesia LLCGroup PAC ID 9032018502, 267 clinicians

Practice addresses (Care Compare)

1034 N 500
Provo, UT 84604-3380
Phone (801) 357-7850

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.53 of 100Reported as group
Quality
89.3
Improvement activities
40
Cost
78.06

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
02004574AINMDAnesthesiology Physician
MED-PHYS-LIC-47547MTMDAnesthesiology Physician
12106328-1204UTMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - Anesthesia PC Anesthesiology CurrentSince Feb 1, 2025 Accepting new patients
Mountain West Anesthesia LLC Anesthesiology CurrentSince Mar 1, 2021 Accepting new patients
Cep America - Anesthesia PC Anesthesiology CurrentSince Feb 1, 2025 Accepting new patients
Granite Peak Anesthesiology Consultants Anesthesiology Past Accepting new patients

Locations

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

2700 NW Stewart Pkwy
Roseburg, OR 97471
Phone (541) 673-0611

3340 N Center St
Ste 800
Lehi, UT 84043
Phone (800) 501-4788

1034 N 500 W
Provo, UT 84604
Phone (801) 362-4119

150 W Civic Center Dr
Ste 200
Sandy, UT 84070
Phone (801) 727-2056

Organizations & group practices 4

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": "1337904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736985600000",
    "number": "1881954634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "334 W 800 S",
            "city": "SALEM",
            "state": "UT",
            "postal_code": "846535611",
            "telephone_number": "208-360-3560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1034 N 500 W",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "84604",
            "telephone_number": "208-360-3560"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1130 W Michigan St",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462025209",
            "country_code": "US",
            "telephone_number": "317-274-0275",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "765 E Market Place Dr",
            "address_purpose": "LOCATION",
            "city": "Spanish Fork",
            "state": "UT",
            "postal_code": "84660",
            "country_code": "US",
            "telephone_number": "208-360-3560",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2800 10th Ave N",
            "address_purpose": "LOCATION",
            "city": "Billings",
            "state": "MT",
            "postal_code": "59101",
            "country_code": "US",
            "telephone_number": "406-238-2500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "MARK",
        "middle_name": "WILSON",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-25",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MT",
            "license": "MED-PHYS-LIC-47547",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IN",
            "license": "02004574A",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OR",
            "license": "DO222639",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "UT",
            "license": "12106328-1204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

Verify at the official NPI Registry.