Individual provider Active NPI

Suzanne Renee Thibodeaux, MD PHD

  • Clinical Pathology Physician
  • Saint Louis, MO
National Provider Identifier
1073958658
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Pathology PhysicianTaxonomy code 207ZC0006X
License
2017030247 Issued in MO
Practice address
425 S Euclid Ave
Div PA Lab and Genomic Med
Saint Louis, MO 63110-1005
Phone
(314) 362-5641
Fax
(314) 362-0369
NPI assigned
May 8, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Pathology Physician 207ZC0006X 2017030247 MO Primary

Addresses

Primary practice location

425 S Euclid Ave
Div PA Lab and Genomic Med
Saint Louis, MO 63110-1005

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 362-5641

Other identifiers 1

IdentifierTypeStateIssuer
200046010MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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

Enrollment IDStateProvider typePAC IDDetails
I20171031001985 MO Practitioner - Pathology 2567738867 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Washington UniversityGroup PAC ID 9830008770, 2,968 clinicians

Practice addresses (Care Compare)

1 Barnes Jewish Hospital PLZ
FL 3
Saint Louis, MO 63110-1003
Phone (314) 362-5641

Hospital & facility affiliations

  • Barnes Jewish Hospital Hospital, Saint Louis, MO, CCN 260032
  • Memorial Hospital Hospital, Belleville, IL, CCN 140185

Merit-based Incentive Payment System (MIPS)

Final score
84.2 of 100Reported as group
Quality
71.6
Promoting interoperability
100
Improvement activities
40
Cost
75.75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University CurrentSince Sep 26, 2017 Accepting new patients
Washington University CurrentSince Sep 26, 2017 Accepting new patients

Locations

660 S Euclid Ave
#C
Saint Louis, MO 63110

1 Barnes Jewish Hospital Plz
Fl 3
Saint Louis, MO 63110

660 S Euclid Ave
#8118
Saint Louis, MO 63110
Phone (314) 362-0101

1 Barnes Hospital Plz
Saint Louis, MO 63110
Phone (314) 362-9170

1 Barnes Jewish Hospital Plz
#P
Saint Louis, MO 63110
Phone (618) 474-1074

Interoperability endpoints

  • Direct secure messaging: sthibodeaux160236@direct.carenet.org

Organizations & group practices 2

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1367971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1073958658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "314-362-5641",
            "fax_number": "314-362-0369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 S EUCLID AVE",
            "address_2": "DIV PA LAB AND GENOMIC MED",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101005",
            "telephone_number": "314-362-5641",
            "fax_number": "314-362-0369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIBODEAUX",
        "first_name": "SUZANNE",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "MD PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-08",
        "last_updated": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZC0006X",
            "taxonomy_group": "",
            "desc": "Pathology, Clinical Pathology",
            "state": "MO",
            "license": "2017030247",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200046010",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "425 S Euclid Ave",
            "address_2": "Div PA Lab and Genomic Med",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631101005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.