Eugene Henry Thiebaud, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

101957 Issued in NC

Practice address

BLDG 200, Robinhood Medical Plaza
Winston Salem, NC 27106-5475

Phone

(336) 718-7950

Fax

(336) 718-7989

NPI assigned

Dec 13, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wake Forest University Health SciencesGroup PAC ID 4486564952, 2,633 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• North Carolina Baptist Hospital Hospital, Winston-Salem, NC, CCN 340047

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ethiebaud2755278@carolinashealthcaresystem.direct-ci.com

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.

• Wake Forest University Health Sciences

  • Multi-Specialty Clinic/Center
  • Winston Salem, NC
  • NPI 1003803032
  Medicare reassignment Care Compare group NPD
• Wake Forest Health Network LLC

  • Pediatrics Physician
  • Greensboro, NC
  • NPI 1477785756
  Medicare reassignment
• Cornerstone Health Care, PA

  • Psychologist
  • Advance, NC
  • NPI 1407291107
  NPD
• Wake Forest Health Network, LLC

  • Pediatrics Physician
  • Greensboro, NC
  • NPI 1053175299
  NPD

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

• North Carolina Baptist Hospital

  • Psychiatric Hospital Unit
  • Winston Salem, NC
  • NPI 1063480531
  Care Compare affiliation
• North Carolina Baptist Hospital

  • Rehabilitation Hospital Unit
  • Winston Salem, NC
  • NPI 1114995677
  Care Compare affiliation
• North Carolina Baptist Hospital

  • General Acute Care Hospital
  • Winston Salem, NC
  • NPI 1144211301
  Care Compare affiliation
• North Carolina Baptist Hospital

  • Clinical Medical Laboratory
  • Winston Salem, NC
  • NPI 1609162098

  Hospital

  Care Compare affiliation
• North Carolina Baptist Hospital

  • Pediatric Adolescent Medicine Physician
  • Winston Salem, NC
  • NPI 1912179219

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1134432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413244800000",
    "number": "1306821269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "336-718-7950",
            "fax_number": "336-718-7989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BLDG 200, ROBINHOOD MEDICAL PLAZA",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271065475",
            "telephone_number": "336-718-7950",
            "fax_number": "336-718-7989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIEBAUD",
        "first_name": "EUGENE",
        "middle_name": "HENRY",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-13",
        "last_updated": "2014-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "101957",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NC",
            "license": "000101957",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "94709",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "970025236",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7400798",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pierre-Richard Didier Theard, MD
• Mary Ann Thenganatt, M.D.
• Theodore Limerick, DDS, P.a.
• Adam Thibeault
• Lia Kay Thibodaux, PH.D.
• Scott Taylor Thiesfeldt, MD
• Jacob Kly Thiessen
• Bernetta Thigpen, MS
• Thomas E Simpson Mdpa
• Thomas Family Care LLC

• Physician Assistant in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2014; 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.