Alisha Renee Thibault-Hladki, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

4301503863 Issued in MI

Practice address

300 68TH Street SE
Pine Rest Christian Mental Health Services
Grand Rapids, MI 49548

Phone

(616) 456-0842

Fax

(616) 559-5864

NPI assigned

Jun 6, 2017

Last updated

Nov 30, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

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

Psychiatry

Education

Michigan State University College of Human Medicine, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Northeast Michigan Community Mental Health AuthorityGroup PAC ID 2264498005, 14 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mymichigan Medical Center Alpena Hospital, Alpena, MI, CCN 230036

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: athibault293771@direct.trinity-health.org

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.

• Northeast Michigan Community Mental Health Authority

  • Community/Behavioral Health Agency
  • Alpena, MI
  • NPI 1144378381
  Medicare reassignment Care Compare group NPD
• Mercy Health Partners

  dba Trinity Health Medical Group

  • Certified Registered Nurse Anesthetist
  • Shelby, MI
  • NPI 1154910172
  Medicare reassignment NPD
• Mercy Health Partners

  dba Hackley Behavioral Health Services

  • Adult Mental Health Clinic/Center
  • Muskegon, MI
  • NPI 1194767186
  NPD
• Hope Network West Michigan

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Sparta, MI
  • NPI 1679558670

  Psychiatry

  NPD (past)

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

• Mymichigan Medical Center Alpena

  • Rural Acute Care Hospital
  • Sault Sainte Marie, MI
  • NPI 1619791431
  Care Compare affiliation
• Mymichigan Medical Center Alpena

  • Rural Acute Care Hospital
  • Alpena, MI
  • NPI 1619914652
  Care Compare affiliation
• Mymichigan Medical Center Alpena

  • Internal Medicine Physician
  • Alpena, MI
  • NPI 1942302302

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1496707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669766400000",
    "number": "1295264034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 68TH STREET SE",
            "address_2": "PINE REST CHRISTIAN MENTAL HEALTH SERVICES",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49548",
            "telephone_number": "616-456-0842",
            "fax_number": "616-559-5864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 68TH STREET SE",
            "address_2": "PINE REST CHRISTIAN MENTAL HEALTH SERVICES",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49548",
            "telephone_number": "616-456-0842",
            "fax_number": "616-559-5864"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "440 Baltimore Dr NE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495033934",
            "country_code": "US",
            "telephone_number": "616-454-4777",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THIBAULT-HLADKI",
        "first_name": "ALISHA",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-06",
        "last_updated": "2022-11-30",
        "certification_date": "2022-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4301111913",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4351032045",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4301503863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theresa a Osmer PC (Flow Chiropractic)
• Theresa Anderson-Varney P.C.
• Thethirdchair
• Bernice Alice Theule, NP-C
• Peter C Theut, MD
• Elisabeth M Thibault
• Chelsea Thibodeau
• Caleb Thiel, M.D.
• Jane Brooke Thiel, WHNP, BC
• Lisa Michele Thiel, D.O.

• Psychiatry Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Psychiatry Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 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.