Michael Edmond Theriault, M.D.

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

MD473446 Issued in PA

Practice address

21 Industrial Blvd
Paoli, PA 19301-1610

Phone

(610) 647-8000

NPI assigned

Apr 11, 2016

Last updated

Nov 3, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

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

Specialty

Neurology

Education

New York Medical College, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Phoenix Rehabilitation and Health Services IncGroup PAC ID 3476464298, shared by 2 NPIs, 2,775 clinicians

Main Line HealthcareGroup PAC ID 1951215201, 1,154 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Main Line Hospital Lankenau Hospital, Wynnewood, PA, CCN 390195
• Paoli Hospital Hospital, Paoli, PA, CCN 390153
• Riddle Memorial Hospital Hospital, Media, PA, CCN 390222
• Bryn Mawr Hospital Hospital, Bryn Mawr, PA, CCN 390139
• Chester County Hospital Hospital, West Chester, PA, CCN 390179
• Bryn Mawr Rehabilitation Hospital Inpatient rehabilitation facility, Malvern, PA, CCN 393025

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.

• Main Line Healthcare

  • Family Medicine Physician
  • Newtown Square, PA
  • NPI 1922077643

  Neurology

  Medicare reassignment Care Compare group NPD

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

• Chester County Hospital

  • General Acute Care Hospital
  • West Chester, PA
  • NPI 1356333579
  Care Compare affiliation
• Main Line Hospitals, Inc.

  dba Paoli Hospital

  • General Acute Care Hospital
  • Paoli, PA
  • NPI 1215042114
  Care Compare affiliation
• Main Line Hospitals, Inc.

  dba Lankenau Hospital

  • General Acute Care Hospital
  • Wynnewood, PA
  • NPI 1245335629
  Care Compare affiliation
• Main Line Hospitals, Inc.

  dba Bryn Mawr Rehabilitation Hospital

  • Rehabilitation Hospital
  • Malvern, PA
  • NPI 1396850368

  Inpatient rehabilitation facility

  Care Compare affiliation
• Main Line Hospitals, Inc.

  dba Bryn Mawr Hospital

  • General Acute Care Hospital
  • Bryn Mawr, PA
  • NPI 1508971441
  Care Compare affiliation
• Riddle Memorial Hospital

  • General Acute Care Hospital
  • Media, PA
  • NPI 1407856099
  Care Compare affiliation

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

{
    "created_epoch": "1460332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635897600000",
    "number": "1083078539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 INDUSTRIAL BLVD",
            "city": "PAOLI",
            "state": "PA",
            "postal_code": "193011610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 INDUSTRIAL BLVD",
            "city": "PAOLI",
            "state": "PA",
            "postal_code": "193011610",
            "telephone_number": "610-647-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THERIAULT",
        "first_name": "MICHAEL",
        "middle_name": "EDMOND",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-11",
        "last_updated": "2021-11-03",
        "certification_date": "2021-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "PA",
            "license": "MD473446",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nita K Thingalaya, M.D.
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• Thomas H. Graham (Graham Neurological Associates)
• Thomas Pingue Pmhnp-BC LLC (Mindful Presence Behavioral Health Services)
• Gregory M. Thompson, M.D.

• Neurology Physician in Paoli, PA
• Providers in Paoli, PA by specialty
• Neurology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.