Alisa Thavikulwat

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

D0087217 Issued in MD

Practice address

12150 Annapolis Rd Ste 111
Glenn Dale, MD 20769-9183

Phone

(301) 779-0844

NPI assigned

Apr 1, 2015

Sex

Female

Sole proprietor

Yes

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 DC

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

Ophthalmology

Education

University of Rochester School of Medicine and Dentistry, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Visionmd, LLCGroup PAC ID 2860732609, 4 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

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.

• Visionmd, LLC

  • Ophthalmology Physician
  • Glenn Dale, MD
  • NPI 1801381884

  DC

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1427846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600905600000",
    "number": "1265827745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1855 W TAYLOR ST",
            "address_2": "DEPARTMENT OF OPHTHALMOLOGY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606127242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12150 ANNAPOLIS RD STE 111",
            "city": "GLENN DALE",
            "state": "MD",
            "postal_code": "207699183",
            "telephone_number": "301-779-0844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THAVIKULWAT",
        "first_name": "ALISA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-04-01",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MD",
            "license": "D0087217",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joan Teke
• Paul Temban Temban
• Erick Tendong
• Claude Tewan Tendo
• Mokom Thaddeus Fon
• The Bariatric and Hernia Institute, PC
• The Haven Homecare LLC
• The Podiatry Care Center, LLC
• Craig Michael Thomas, M.D.
• Barry Eugene Thompson, PA-C

• Ophthalmology Physician in Glenn Dale, MD
• Providers in Glenn Dale, MD by specialty
• Ophthalmology Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2020; 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.