Marie-Josee Thibault, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

A51019 Issued in CA

Practice address

5767 W Century Blvd
Suite 200
Los Angeles, CA 90045-5632

Phone

(310) 301-8708

Fax

(310) 301-8751

NPI assigned

May 8, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Methodist Medical Center of Illinois

  • Rehabilitation Hospital Unit
  • Peoria, IL
  • NPI 1982656575
  Medicare reassignment NPD
• Proctor Health Systems

  • Family Medicine Physician
  • Peoria, IL
  • NPI 1134173917
  Medicare reassignment NPD
• Methodist Medical Center of Illinois

  • General Acute Care Hospital
  • Peoria, IL
  • NPI 1164474755
  NPD
• Methodist Medical Center of Illinois

  • Psychiatric Hospital Unit
  • Peoria, IL
  • NPI 1275583155
  NPD
• Proctor Health Systems

  dba Carle Health Princeville

  • Rural Health Clinic/Center
  • Princeville, IL
  • NPI 1356057301
  NPD
• California Pacific Medical Group, Inc.

  dba Brown & Toland Medical Group

  • Multi-Specialty Clinic/Center
  • Oakland, CA
  • NPI 1275002453
  NPD (past)

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

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604620800000",
    "number": "1033168042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 HIGHWAY 34 E",
            "address_2": "STE B",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302651325",
            "telephone_number": "310-301-8708",
            "fax_number": "310-301-8751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD",
            "address_2": "SUITE 200",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455632",
            "telephone_number": "310-301-8708",
            "fax_number": "310-301-8751"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "559 Abbott St Ste A",
            "address_purpose": "LOCATION",
            "city": "Salinas",
            "state": "CA",
            "postal_code": "939014325",
            "country_code": "US",
            "telephone_number": "831-757-1007",
            "fax_number": "831-757-0352",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9460 N Name Uno Ste 210",
            "address_purpose": "LOCATION",
            "city": "Gilroy",
            "state": "CA",
            "postal_code": "950203532",
            "country_code": "US",
            "telephone_number": "408-847-0888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THIBAULT",
        "first_name": "MARIE-JOSEE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-08",
        "last_updated": "2020-11-06",
        "certification_date": "2020-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "GA",
            "license": "84458",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "CA",
            "license": "A51019",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A51019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A510190",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bowen Thi
• Long Thi
• Samanda Lee Thi, PA-C
• Stephanie Ann Thi
• William Jon Thi, MD
• Mark Anthony Thibodeau Sr.
• Sheila Emily Thiele
• Thien C Nguyen, DDS, a Dental Corporation
• Deonisha Jenay Thigpen, PSYD
• Lisa Thigpen

• Dermatology Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.