NPIMap

Individual provider Active NPI

Alexander L Thacker, M.D

  • Family Medicine Physician
  • Bradenton, FL
National Provider Identifier
1902152358
Registry record updated Oct 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME119802 Issued in FL
Practice address
11715 Rangeland Pkwy
Bradenton, FL 34211-9529
Phone
(941) 538-0001
Fax
(941) 538-0002
NPI assigned
Aug 2, 2012
Last updated
Oct 18, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME119802 FL Primary

Addresses

Primary practice location

11715 Rangeland Pkwy
Bradenton, FL 34211-9529

Mailing address

11715 Rangeland Pkwy
Bradenton, FL 34211-9529
Phone (941) 538-0001

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Alexander.Thacker@img.directbygreenway.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20140819002672 FL Practitioner - Family Practice 2163640962 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Cora Health Services IncGroup PAC ID 1759290992, shared by 21 NPIs, 1,125 clinicians
Intercoastal Medical Group IncGroup PAC ID 6305730912, 176 clinicians
Legacy Healthcare Services IncGroup PAC ID 2163339722, shared by 46 NPIs, 3,431 clinicians
H2 Rehabilitation Services of Florida LLCGroup PAC ID 3971411851, shared by 10 NPIs, 257 clinicians

Practice addresses (Care Compare)

11661 State Rd 70
Lakewood Ranch, FL 34202-9416
Phone (941) 222-0321

11715 Rangeland Pkwy
Bradenton, FL 34211-9529
Phone (941) 538-0001

17470 Brookside Trace CT
Tampa, FL 33647-6201
Phone (813) 443-5042

8220 Natures Way
Apt 201
Lakewood Ranch, FL 34202-4208
Phone (800) 699-9395

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hernia repair (minimally invasive)1-10
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME119802FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Intercoastal Medical Group Inc Family Medicine CurrentSince Sep 23, 2021 Accepting new patients
Intercoastal Medical Group Inc Family Medicine CurrentSince Sep 1, 2014 Accepting new patients

Locations

11505 Rangeland Pkwy
Bradenton, FL 34211
Phone (941) 362-8662

11715 Rangeland Pkwy
Bradenton, FL 34211
Phone (941) 538-0001

921 S Beneva Rd
Sarasota, FL 34232
Phone (941) 365-7390

943 S Beneva Rd
Ste 306
Sarasota, FL 34232
Phone (941) 362-8644

Interoperability endpoints

  • Direct secure messaging: alexander.thacker@img.directbygreenway.com
  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.70573

Organizations & group practices 2

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.

Hospital & facility affiliations 9

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": "1343865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729209600000",
    "number": "1902152358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11715 RANGELAND PKWY",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342119529",
            "telephone_number": "941-538-0001",
            "fax_number": "941-538-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11715 RANGELAND PKWY",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342119529",
            "telephone_number": "941-538-0001",
            "fax_number": "941-538-0002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THACKER",
        "first_name": "ALEXANDER",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-02",
        "last_updated": "2024-10-18",
        "certification_date": "2024-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME119802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Alexander.Thacker@img.directbygreenway.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "11715 Rangeland Pkwy",
            "city": "Bradenton",
            "state": "FL",
            "country_code": "US",
            "postal_code": "342119529",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bradenton, FL

Sources for this page

Verify at the official NPI Registry.