NPIMap

Individual provider Active NPI

William N Thibault, MD

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Orange, CA
National Provider Identifier
1417981929
Registry record updated May 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
G19938 Issued in CA
Practice address
1310 W. Stewart Drive
Suite 503
Orange, CA 92868-3856
Phone
(714) 997-2224
Fax
(714) 997-1187
NPI assigned
Jul 10, 2006
Last updated
May 6, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X G19938 CA Primary

Addresses

Primary practice location

1310 W. Stewart Drive
Suite 503
Orange, CA 92868-3856

Mailing address

PO Box 7462
Orange, CA 92863-7462
Phone (714) 571-5000

Other identifiers 2

IdentifierTypeStateIssuer
G19938OtherCALICENSE
00G199380MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090317000153 CA Practitioner - Thoracic SurgeryPractitioner - Cardiac Surgery 1759334170 Reassigns benefits to 1 organization
Practice locations: Orange, CA

Care Compare profile

Medicare Care Compare
Specialty
Thoracic Surgery
Education
University of Vermont College of Medicine, 1969
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1310 W Stewart Dr
Suite 503
Orange, CA 92868-3856
Phone (714) 997-2224

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary artery bypass graft (CABG)12

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G19938CAMDThoracic Surgery (Cardiothoracic Vascular Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mission Hospital Regional Medical Center Past Accepting new patients
Saddleback Memorial Medical Center Past Accepting new patients
St Jude Hospital Inc Past Accepting new patients
Midcoast Imaging Medical Group PastSince Feb 16, 2020 Accepting new patients
Carlos Blanche MD a Medical Corporation Past Accepting new patients
Orange Coast Memorial Medical Center Past Accepting new patients
Hoag Memorial Hospital Presbyterian Past Accepting new patients
St Joseph Hospital of Orange Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 9

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430870400000",
    "number": "1417981929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7462",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928637462",
            "telephone_number": "714-571-5000",
            "fax_number": "714-571-5055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 W. STEWART DRIVE",
            "address_2": "SUITE 503",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683856",
            "telephone_number": "714-997-2224",
            "fax_number": "714-997-1187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIBAULT",
        "first_name": "WILLIAM",
        "middle_name": "N",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2015-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "CA",
            "license": "G19938",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "G19938",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G199380",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

Verify at the official NPI Registry.