Jonathan David Thackeray, MD

Primary specialty

Child Abuse Pediatrics PhysicianTaxonomy code 2080C0008X

License

35.083628 Issued in OH

Practice address

1 Childrens PLZ
Dayton, OH 45404-1815

Phone

(937) 641-4000

Fax

(937) 641-3918

NPI assigned

Aug 10, 2005

Last updated

Oct 12, 2023By the provider in NPPES

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 1

Medicare fee-for-service enrollment

Enrolled in OH

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Children's Home Care of Dayton

  • Home Health Agency
  • Dayton, OH
  • NPI 1477722031

  Corporate Officer

  CMS ownership
• Children's Home Care of Dayton

  • Home Infusion Therapy Pharmacy
  • Dayton, OH
  • NPI 1700883741

  Corporate Officer

  CMS ownership

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.

• Dayton Children's Specialty Physicians, Inc.

  • Pediatrics Physician
  • Dayton, OH
  • NPI 1225192610
  Medicare reassignment NPD
• Dayton Children's Specialty Physicians, Inc.

  • Pediatrics Physician
  • Dayton, OH
  • NPI 1780467555
  NPD

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

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697068800000",
    "number": "1437151453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 933432",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441930039",
            "telephone_number": "937-641-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS PLZ",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454041815",
            "telephone_number": "937-641-4000",
            "fax_number": "937-641-3918"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1010 Valley St",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454042070",
            "country_code": "US",
            "telephone_number": "937-641-4000",
            "fax_number": "937-641-3918",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "410 Valley St",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454041843",
            "country_code": "US",
            "telephone_number": "937-641-4000",
            "fax_number": "937-641-3918",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "600 Buckskin Trl",
            "address_purpose": "LOCATION",
            "city": "Xenia",
            "state": "OH",
            "postal_code": "453854108",
            "country_code": "US",
            "telephone_number": "937-641-4623",
            "fax_number": "937-641-6138",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THACKERAY",
        "first_name": "JONATHAN",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-10",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35.083628",
            "primary": false
        },
        {
            "code": "2080C0008X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Child Abuse Pediatrics",
            "state": "OH",
            "license": "35.083628",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2545026",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Courtney Tester
• Martha Teter, CRNP
• Ryan Tetla, MD
• Jennifer R Tettenhorst
• Julie Teuschler
• Khang Thai
• Gnan N Thakore, M.D.
• Jigna Thakore, MD
• Gnanam Thambi Pillai, MD
• Sophia George Thankaraj, D.D.S.

• Pediatrics Physician in Dayton, OH
• Providers in Dayton, OH by specialty
• Pediatrics Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.