Bryan C Thibodeau, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

N2840 Issued in TX

Practice address

12221 Merit Dr
Suite 1610
Dallas, TX 75251-2202

Phone

(214) 217-1912

NPI assigned

Mar 10, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in TX

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 and National Provider Directory roles.

• Emcare RSN Emergency Physicians PLLC

  • Emergency Medicine Physician
  • Richardson, TX
  • NPI 1427008523
  Medicare reassignment NPD
• Questcare Medical Services, PLLC

  • Emergency Medicine Physician
  • Dallas, TX
  • NPI 1912059247
  Medicare reassignment NPD
• Questcare Medical Services, PLLC

  • Nurse Practitioner
  • Arlington, TX
  • NPI 1497807713

  Emergency Medicine

  NPD

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

{
    "created_epoch": "1173484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274918400000",
    "number": "1083746507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12221 MERIT DR",
            "address_2": "SUITE 1610",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752512202",
            "telephone_number": "214-217-1912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12221 MERIT DR",
            "address_2": "SUITE 1610",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752512202",
            "telephone_number": "214-217-1912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIBODEAU",
        "first_name": "BRYAN",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-10",
        "last_updated": "2010-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "N2840",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203457101",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8CA552",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "P00814340",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thi of Texas at Dallas, LLC
• Thi of Texas at Dallas, LLC
• Thi of Texas at Forest Lane, LLC
• Thi of Texas at Samaritan Hospice LLC
• Donald Eugene Thibeaux, LCSW, LCDC
• Jennifer Taylor Thibodeau, M.D.
• Mary Collins Thibodeaux, LMSW
• Dwain Louis Thiele, MD
• Lisa Renee Thiele
• Melissa Thiele

• Emergency Medicine Physician in Dallas, TX
• Providers in Dallas, TX by specialty
• Emergency Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2010; 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.