Mark A Thiele, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4659 Issued in AZ

Practice address

1223 Willow Creek Rd
Prescott, AZ 86301-1427

Phone

(928) 777-9950

Fax

(928) 777-9975

NPI assigned

May 27, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AZ

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

Specialty

Physician Assistant

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Granite Orthopaedics PLLCGroup PAC ID 6305025669, 12 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Yavapai Regional Medical Center Hospital, Prescott, AZ, CCN 030012
• Arizona Orthopedic and Surgical Specialty Hospital Hospital, Phoenix, AZ, CCN 030112

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Granite Orthopaedics PLLC

  • Orthopaedic Surgery Physician
  • Prescott, AZ
  • NPI 1831408384
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Orthopedic and Surgical Specialty Company, LLC

  • Special Hospital
  • Phoenix, AZ
  • NPI 1124163530
  Care Compare affiliation
• Yavapai Community Hospital Association

  • General Acute Care Hospital
  • Prescott, AZ
  • NPI 1902897820
  Care Compare affiliation

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

{
    "created_epoch": "1117152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490745600000",
    "number": "1992708523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1223 WILLOW CREEK RD",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011427",
            "telephone_number": "928-777-9950",
            "fax_number": "928-777-9975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1223 WILLOW CREEK RD",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011427",
            "telephone_number": "928-777-9950",
            "fax_number": "928-777-9975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIELE",
        "first_name": "MARK",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-27",
        "last_updated": "2017-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "4659",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291957500",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "782816",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• The Evangelical Lutheran Good Samaritan Society
• The Servant Group LLC
• The Wellness Hub PLLC
• Therapy Nest, PLLC
• Joanne Lorraine Therriault, D.C
• Emily Tholson, RDN
• Thomas H. Hirasa, M.D., PLLC
• Harvey G Thomas, MD
• James Owen Thomas, LISAC
• Marie Irene Thomas, PA-C

• Physician Assistant in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.