NPIMap

Organization Active NPI

Adly Thebaud,MD,PA

  • Community/Behavioral Health Agency
  • Orange City, FL
National Provider Identifier
1417018482
Registry record updated Jun 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
ADLY THEBAUD,MD,PA
Practice address
2725 Rebecca LN Ste 107
Orange City, FL 32763-8350
Phone
(386) 775-0736
Fax
(386) 775-0738
NPI assigned
Dec 13, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Adly ThebaudNPI 1629049770
Title
Owner/Provider
Phone
(386) 775-0736

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20050124001039 FL Part B Supplier - Clinic/Group Practice 0143270579 Receives reassigned benefits from 5 practitioners
Practice locations: Orange City, FL

National Provider Directory

National Provider Directory

Locations

2725 Rebecca Ln
Ste 107
Orange City, FL 32763
Phone (386) 775-0736

2725 Rebecca Ln
Ste 103
Orange City, FL 32763

1403 Medical Plaza Dr
Ste 202
Sanford, FL 32771
Phone (407) 322-3096

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0804X ME60436 FL
Community/Behavioral Health Agency 251S00000X FL Primary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LP0808X ARNP 9410846 FL

Addresses

NPPES NPI Registry

Primary practice location

2725 Rebecca LN Ste 107
Orange City, FL 32763-8350

Mailing address

2725 Rebecca LN Ste 107
Orange City, FL 32763-8350
Phone (386) 775-0736

Other identifiers 3

NPPES NPI Registry
IdentifierTypeStateIssuer
010364600MedicaidFL
W9584OtherFLMEDICARE
K0231OtherFLMEDICARE

Other names 1

NPPES NPI Registry
  • Family Psychiatry Services Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 10, 2026.

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781049600000",
    "number": "1417018482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2725 REBECCA LN STE 107",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327638350",
            "telephone_number": "386-775-0736",
            "fax_number": "386-775-0738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2725 REBECCA LN STE 107",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327638350",
            "telephone_number": "386-775-0736",
            "fax_number": "386-775-0738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADLY THEBAUD,MD,PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2026-06-10",
        "certification_date": "2026-06-10",
        "status": "A",
        "authorized_official_last_name": "THEBAUD",
        "authorized_official_first_name": "ADLY",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "386-775-0736"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "FL",
            "license": "ME60436",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "FL",
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "ARNP 9410846",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010364600",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "W9584",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "K0231",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Psychiatry Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Psychiatry Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orange City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.