Active NPI
Joseph C Theriault, CNM
- Advanced Practice Midwife
- Toledo, OH
National Provider Identifier
1063410843
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Advanced Practice Midwife
- License
- NM-04290
- Practice address
- 2142 N Cove Blvd
Toledo, OH 43606-3895 - Phone
- (419) 291-8541
- Fax
- (419) 480-1340
- NPI assigned
- Jul 14, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Midwife | 176B00000X | 04290 | OH | |
| Advanced Practice Midwife | 367A00000X | NM-04290 | OH | Primary |
Addresses
Primary practice location
2142 N Cove Blvd
Toledo, OH 43606-3895
Mailing address
2142 N Cove Blvd
Toledo, OH 43606-3895
Phone (419) 291-8541
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000031422 | Other | OH | ANTHEM |
| 2065045 | Medicaid | OH | |
| 05225 | Other | OH | PARAMOUNT |
| 3471545 | Medicaid | MI | |
| 344428256 | Other | OH | BEECHSTREET |
| 344428256 | Other | OH | FRONTPATH |
| 344428256090 | Other | OH | CARESOURCE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Midwife
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04290 | OH | MD | Midwife |
| NM-04290 | OH | MD | Advanced Practice Midwife |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1392768000000",
"number": "1063410843",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2142 N COVE BLVD",
"city": "TOLEDO",
"state": "OH",
"postal_code": "436063895",
"telephone_number": "419-291-8541",
"fax_number": "419-480-1340"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2142 N COVE BLVD",
"city": "TOLEDO",
"state": "OH",
"postal_code": "436063895",
"telephone_number": "419-291-8541",
"fax_number": "419-480-1340"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THERIAULT",
"first_name": "JOSEPH",
"middle_name": "C",
"credential": "CNM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-14",
"last_updated": "2014-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "176B00000X",
"taxonomy_group": "",
"desc": "Midwife",
"state": "OH",
"license": "04290",
"primary": false
},
{
"code": "367A00000X",
"taxonomy_group": "",
"desc": "Advanced Practice Midwife",
"state": "OH",
"license": "NM-04290",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000031422",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2065045",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PARAMOUNT",
"identifier": "05225",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3471545",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BEECHSTREET",
"identifier": "344428256",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FRONTPATH",
"identifier": "344428256",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARESOURCE",
"identifier": "344428256090",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Toledo, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.