MARK K THALACKER CNP
NPI 1063483493
Nurse Practitioner in Woodbury, MN
About Mark K Thalacker Cnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MARK K THALACKER CNP (NPI 1063483493) is an individual nurse practitioner in Woodbury, Minnesota, licensed in Minnesota (R096321-5) and active in the NPI registry since February 2006. He is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Mark K Thalacker Cnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Mark Thalacker reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Woodbury, MN 55125
- Reassigned Medicare billing, Minnesota enrollment
- Medicare enrollment name: Healtheast Medical Research Institute
- 2,361 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 55125 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Medicare Quality Performance CMS QPP · MIPS
Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.
Referred Medical Equipment & Supplies CMS DME claims 2
Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
WOODBURY, MN 55125
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Mark Thalacker's NPI number?
The NPI number for Mark Thalacker is 1063483493. It was assigned to this individual provider in the NPPES registry on February 1, 2006.
Where is Mark Thalacker located?
Mark Thalacker practices at 1875 Woodwinds Dr Suite 130, Woodbury, MN 55125. The listed phone number is (651) 232-0500.
What is Mark Thalacker's specialty?
The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.
Is Mark Thalacker enrolled in Medicare?
Yes. Mark Thalacker is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Mark Thalacker's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Mark Thalacker reassigns Medicare benefits to Healtheast Medical Research Insititue (Woodbury, MN). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Mark Thalacker's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Mark Thalacker was last updated on February 26, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Mark K Thalacker, CNP · NPI 1063483493
Nurse Practitioner physician in Woodbury, Minnesota. Individual provider, active in the CMS NPPES registry since February 1, 2006.
## Identity
- **NPI:** 1063483493 (Entity type: Individual)
- **Enumerated:** February 1, 2006
- **Primary specialty:** Nurse Practitioner · taxonomy 363L00000X
- **State license:** R096321-5 (Minnesota)
- **Sole proprietor:** No
## Practice location
- **Address:** 1875 WOODWINDS DR, SUITE 130, Woodbury, MN 55125-2298
- **Phone:** (651) 232-0500
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Healtheast Medical Research Insititue (NPI 1013696277, Woodbury, MN), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** February 26, 2024
- **Other identifiers:** Medicaid 815725100 (MN)
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Source: [NPI Profile](https://npiprofile.com/npi/1063483493) · Data from the CMS NPPES public registry.