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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

JACKSON THATCHER
NPI 1174500177
Internal Medicine - Interventional Cardiology in St Louis Park, MN

Active since December 30, 2005PECOS Enrolled
6500 EXCELSIOR BLVD, ST LOUIS PARK, MN 55426(952) 993-3246 Get Directions Write a Review

NPPES record last updated: July 13, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Jackson Thatcher NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACKSON THATCHER (NPI 1174500177) is an individual interventional cardiology provider in St Louis Park, Minnesota, licensed in Minnesota (31870) and active in the NPI registry since December 2005. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1174500177
Entity TypeIndividualMale
Primary Taxonomy207RI0011X
Provider Legal NameJACKSON THATCHER
Location Address6500 EXCELSIOR BLVDSt Louis Park, MN 55426-4702
Mailing Address6465 Wayzata Blvd, Ste 315Minneapolis, MN 55426-1728
Phone(952) 993-3246
Sole ProprietorNo
Enumeration DateDecember 30, 2005
Last NPPES UpdateJuly 13, 2026
✔ NPI 1174500177 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · Interventional CardiologyAllopathic & Osteopathic Physicians
Taxonomy Code207RI0011X
License✔ Licensed in MN · 31870
Definition
An area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart and uses technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system.
6500 EXCELSIOR BLVD, St Louis Park, MN 55426
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jackson Thatcher is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55426 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$127.61 typical visit price
range $56.00 – $168.28
Typical copayment $31.90 (range $14.00 – $42.07)
Most-billed visit code 99204
Established Patient
$98.61 typical visit price
range $18.32 – $138.04
Typical copayment $24.65 (range $4.58 – $34.51)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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.

NANCY COLE NELSON M.D.
Obstetrics & Gynecology
6500 EXCELSIOR BLVD
ST LOUIS PARK, MN 55426
Hennepin County (952) 993-3282
DR. KATIE LYNN ANDRINAS MD, MPH
Obstetrics & Gynecology
6500 EXCELSIOR BLVD
ST LOUIS PARK, MN 55426
Hennepin County (952) 993-3282
CARA HOULE MD
Internal Medicine
6500 EXCELSIOR BLVD
ST LOUIS PARK, MN 55426
Hennepin County (952) 993-5000
JANET GRAYSON MD
Internal Medicine
6500 EXCELSIOR BLVD
ST LOUIS PARK, MN 55426
Hennepin County (952) 993-6600
JEFFREY J SHULTZ
Internal Medicine (Cardiovascular Disease)
6500 EXCELSIOR BLVD, PARK NICOLLET CLINIC - HEART & VASCULAR CENTER
ST LOUIS PARK, MN 55426
Hennepin County (952) 993-3246
MARY BETH JOHNSON OTR/L
Occupational Therapist
6500 EXCELSIOR BLVD
ST LOUIS PARK, MN 55426
Hennepin County (952) 993-6087
MARY KATHERINE KOSANDA P.T.
Physical Therapist
6500 EXCELSIOR BLVD
ST LOUIS PARK, MN 55426
Hennepin County (952) 993-6014
JENNIFER A DEUTZ P.T.
Physical Therapist
6500 EXCELSIOR BLVD
ST LOUIS PARK, MN 55426
Hennepin County (952) 993-5900

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 Jackson Thatcher's NPI number?

The NPI number for Jackson Thatcher is 1174500177. It was assigned to this individual provider in the NPPES registry on December 30, 2005.

Where is Jackson Thatcher located?

Jackson Thatcher practices at 6500 Excelsior Blvd, St Louis Park, MN 55426. The listed phone number is (952) 993-3246.

What is Jackson Thatcher's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Interventional Cardiology, with taxonomy code 207RI0011X.

Is Jackson Thatcher enrolled in Medicare?

Yes. Jackson Thatcher is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jackson Thatcher was last updated on July 13, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 37 days 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.