Active NPI
Jill Thiede, MD, RD
- General Practice Physician
- Camp Pendleton, CA
National Provider Identifier
1265916167
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 2024034082
- Practice address
- H200 Mercy Circle
Camp Pendleton, CA 92055 - Phone
- (682) 885-7960
- NPI assigned
- Sep 18, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nutrition Registered Dietitian | 133VN1004X | DT85560 | TX | |
| Military Health Care Provider | 171000000X | |||
| General Practice Physician | 208D00000X | 2024034082 | MO | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
H200 Mercy Circle
Camp Pendleton, CA 92055
Mailing address
H200 Mercy Circle
Camp Pendleton, CA 92055
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DT85560 | Other | TX | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DT85560 | TX | MD | Pediatric Nutrition Registered Dietitian |
| 2024034082 | MO | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1537228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725494400000",
"number": "1265916167",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "H200 MERCY CIRCLE",
"city": "CAMP PENDLETON",
"state": "CA",
"postal_code": "92055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "H200 MERCY CIRCLE",
"city": "CAMP PENDLETON",
"state": "CA",
"postal_code": "92055",
"telephone_number": "682-885-7960"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THIEDE",
"first_name": "JILL",
"credential": "MD, RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-09-18",
"last_updated": "2024-09-05",
"certification_date": "2024-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "133VN1004X",
"taxonomy_group": "",
"desc": "Dietitian, Registered, Nutrition, Pediatric",
"state": "TX",
"license": "DT85560",
"primary": false
},
{
"code": "171000000X",
"taxonomy_group": "",
"desc": "Military Health Care Provider",
"state": null,
"license": null,
"primary": false
},
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "MO",
"license": "2024034082",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "DT85560",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Camp Pendleton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2024; 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.