Individual provider Active NPI

John P Thalken, MD

  • Internal Medicine Physician
  • Douglas, WY
National Provider Identifier
1912007212
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
3634A Issued in WY
Practice address
111 S 5TH St
Douglas, WY 82633-2434
Phone
(307) 358-2122
Fax
(307) 358-9216
NPI assigned
Sep 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 3634A WY Primary

Addresses

Primary practice location

111 S 5TH St
Douglas, WY 82633-2434

Mailing address

111 S 5TH St
Douglas, WY 82633-2434
Phone (307) 358-2122

Other identifiers 1

IdentifierTypeStateIssuer
312719OtherWYBCBS OF WYOMING

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY
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 1

Enrollment IDStateProvider typePAC IDDetails
I20040428000007 WY Practitioner - Internal Medicine 6901893361 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3634AWYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital of Converse County CurrentSince May 16, 2011 Accepting new patients
Memorial Hospital of Converse County Current Accepting new patients

Locations

700 E Center St
Douglas, WY 82633
Phone (307) 352-8946

111 S 5th St
Douglas, WY 82633
Phone (307) 358-6200

1356 Shiek St
Wheatland, WY 82201
Phone (307) 322-3861

201 14th St
Wheatland, WY 82201
Phone (307) 322-3636

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1912007212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 S 5TH ST",
            "city": "DOUGLAS",
            "state": "WY",
            "postal_code": "826332434",
            "telephone_number": "307-358-2122",
            "fax_number": "307-358-9216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S 5TH ST",
            "city": "DOUGLAS",
            "state": "WY",
            "postal_code": "826332434",
            "telephone_number": "307-358-2122",
            "fax_number": "307-358-9216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THALKEN",
        "first_name": "JOHN",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WY",
            "license": "3634A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF WYOMING",
            "identifier": "312719",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Douglas, WY

Sources for this page

Verify at the official NPI Registry.