Brandon Michael Theriault, DO

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

5151015368 Issued in MI

Practice address

36500 S Gratiot Ave Ste 102
Clinton Township, MI 48035-1772

Phone

(586) 790-9003

Fax

(586) 493-3603

NPI assigned

Mar 29, 2022

Last updated

Apr 29, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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

Internal Medicine

Education

Lincoln Mem Univ, Debusk Col of Osteopathic Med, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mercy Hospitalists, PLLCGroup PAC ID 8921338237, 27 clinicians

Hospitalist Service of Michigan LLCGroup PAC ID 9436259819, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Heart to Heart Hospice of Detroit, LLC Hospice, Bingham Farms, MI, CCN 231625
• Trinity Health Oakland Hospital Hospital, Pontiac, MI, CCN 230029
• Huron Valley-Sinai Hospital Hospital, Commerce Township, MI, CCN 230277

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: brandon.theriault.1@16555.direct.athenahealth.com

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.

• Mercy Hospitalists, PLLC

  • Endocrinology, Diabetes & Metabolism Physician
  • Bloomfield Hills, MI
  • NPI 1790340958

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Hospitalist Service of Michigan, LLC

  • Internal Medicine Physician
  • Bloomfield Hills, MI
  • NPI 1518186758
  Medicare reassignment Care Compare group
• Clarkston Internal Medicine, P.C.

  • Internal Medicine Physician
  • Clarkston, MI
  • NPI 1417085085

  Single Specialty

  NPD
• St Joseph Mercy Hospital-SMHC

  dba St Joseph Mercy Oakland

  • General Acute Care Hospital
  • Pontiac, MI
  • NPI 1053356352
  NPD (past)

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

• Heart to Heart Hospice of Detroit LLC

  • Community Based Hospice Care Agency
  • Bingham Farms, MI
  • NPI 1831485697
  Care Compare affiliation
• St Joseph Mercy Hospital-SMHC

  dba St Joseph Mercy Oakland

  • General Acute Care Hospital
  • Pontiac, MI
  • NPI 1053356352
  Care Compare affiliation
• VHS Huron Valley-Sinai Hospital Inc

  dba Huron Valley-Sinai Hospital

  • General Acute Care Hospital
  • Commerce Township, MI
  • NPI 1922310200
  Care Compare affiliation

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

{
    "created_epoch": "1648512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651190400000",
    "number": "1144970369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36500 S GRATIOT AVE STE 102",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480351772",
            "telephone_number": "586-790-9003",
            "fax_number": "586-493-3603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36500 S GRATIOT AVE STE 102",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480351772",
            "telephone_number": "586-790-9003",
            "fax_number": "586-493-3603"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Harrington St",
            "address_purpose": "LOCATION",
            "city": "Mount Clemens",
            "state": "MI",
            "postal_code": "480432920",
            "country_code": "US",
            "telephone_number": "586-493-8749",
            "fax_number": "586-493-3250",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THERIAULT",
        "first_name": "BRANDON",
        "middle_name": "MICHAEL",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-03-29",
        "last_updated": "2022-04-29",
        "certification_date": "2022-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5151015368",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Salvation Army Harbor Light Macomb
• The Spirit of Oneness
• The Talking Shop LLC
• Theramatrix, Inc.
• Therapy Alliance of Michigan, Inc.
• Rachel Victoria Thill, M.A. CCC-SLP
• Kiran Sooraj Thirukonda Jegadeesh Babu, MD
• Thomas C Hosey DPM & Associates PC
• Thomas D Schomaker DO PC
• Anil K Thomas, MD

• Internal Medicine Physician in Clinton Township, MI
• Providers in Clinton Township, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2022; 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.