Individual provider Active NPI

Adrianna Margaux Thibault, MD

  • Family Medicine Physician
  • Traverse City, MI
National Provider Identifier
1427677608
Registry record updated Jul 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301508756 Issued in MI
Practice address
1400 Medical Campus Dr
Traverse City, MI 49684-7823
Phone
(231) 931-8012
NPI assigned
Apr 8, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301508756 MI Primary

Addresses

Primary practice location

1400 Medical Campus Dr
Traverse City, MI 49684-7823

Mailing address

1400 Medical Campus Dr
Traverse City, MI 49684-7823
Phone (231) 931-8012

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20240515000192 MI Practitioner - Family Practice 0648611194 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Silver Pine Medical Group PLCGroup PAC ID 8325020332, 39 clinicians

Practice addresses (Care Compare)

36555 26 Mile Rd
Suite 2500
Lenox, MI 48048-3102
Phone (586) 726-4823

Hospital & facility affiliations

  • Beaumont Hospital, Troy Hospital, Troy, MI, CCN 230269
  • Beaumont Hospital - Grosse Pointe Hospital, Grosse Pointe, MI, CCN 230089
  • Beaumont Hospital Royal Oak Hospital, Royal Oak, MI, CCN 230130

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301508756MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Silver Pine Medical Group PLC Family Medicine CurrentSince Jun 1, 2024 Accepting new patients
Bayside Family Medicine Chesterfield PC Family Medicine PastSince Oct 6, 2009 Accepting new patients

Locations

31225 23 Mile Rd
Chesterfield, MI 48047
Phone (586) 598-2900

36555 26 Mile Rd
Ste 2500
Lenox, MI 48048

15959 Hall Rd
Ste 110
Macomb, MI 48044

53950 Van Dyke Ave
Shelby Township, MI 48316
Phone (248) 293-0055

13860 Canal Rd
Sterling Heights, MI 48313
Phone (248) 254-8900

43455 Schoenherr Rd
Ste 2
Sterling Hts, MI 48313
Phone (586) 884-2712

Interoperability endpoints

  • Direct secure messaging: adriannathibault@spmgsh.allscriptsdirect.net
  • Direct secure messaging: athibault1021437@direct.hfhs.org

Organizations & group practices 2

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.

Hospital & facility affiliations 4

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": "1586304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720483200000",
    "number": "1427677608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 MEDICAL CAMPUS DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847823",
            "telephone_number": "231-931-8012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 MEDICAL CAMPUS DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847823",
            "telephone_number": "231-931-8012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIBAULT",
        "first_name": "ADRIANNA",
        "middle_name": "MARGAUX",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-08",
        "last_updated": "2024-07-09",
        "certification_date": "2024-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301508756",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

Verify at the official NPI Registry.