Individual provider Active NPI

Marc A Theroux, MD

  • Internal Medicine Physician
  • Fall River, MA
National Provider Identifier
1497742514
Registry record updated Apr 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
72558 Issued in MA
Practice address
534 Prospect St
Fall River, MA 02720-5239
Phone
(508) 973-7766
Fax
(508) 973-7753
NPI assigned
Oct 4, 2005
Last updated
Apr 27, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 72558 MA Primary
Internal Medicine Physician 207R00000X MD08048 RI

Addresses

Primary practice location

534 Prospect St
Fall River, MA 02720-5239

Mailing address

200 Mill Rd
Ste 180
Fairhaven, MA 02719-5252
Phone (508) 973-2000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mtheroux6438@direct.southcoast.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, RI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20050405000969 MA Practitioner - Internal Medicine 5193772812 Reassigns benefits to 2 organizations
I20050505000147 RI Practitioner - Internal Medicine 5193772812 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southcoast Hospitals Group, Inc CurrentSince Oct 1, 2006 Accepting new patients
Southcoast Hospitals Group Inc CurrentSince Oct 1, 2006 Accepting new patients
Southcoast Physicians Group, Inc. Internal Medicine CurrentSince May 2, 1990 Accepting new patients

Locations

200 Mill Rd
Ste 180
Fairhaven, MA 02719
Phone (508) 973-2000

300 Hanover St
Fall River, MA 02720
Phone (508) 677-0700

363 Highland Ave
Fall River, MA 02720
Phone (508) 679-7052

534 Prospect St
Fall River, MA 02720
Phone (508) 679-7766

874 Purchase St
New Bedford, MA 02740
Phone (508) 992-6553

Interoperability endpoints

  • Direct secure messaging: mtheroux6438@direct.southcoast.org

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587945600000",
    "number": "1497742514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MILL RD",
            "address_2": "STE 180",
            "city": "FAIRHAVEN",
            "state": "MA",
            "postal_code": "027195252",
            "telephone_number": "508-973-2000",
            "fax_number": "508-973-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "534 PROSPECT ST",
            "city": "FALL RIVER",
            "state": "MA",
            "postal_code": "027205239",
            "telephone_number": "508-973-7766",
            "fax_number": "508-973-7753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEROUX",
        "first_name": "MARC",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-04",
        "last_updated": "2020-04-27",
        "certification_date": "2020-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "72558",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "RI",
            "license": "MD08048",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mtheroux6438@direct.southcoast.org",
            "affiliation": "N",
            "endpointDescription": "Southcoast Health Epic Direct Address",
            "address_1": "534 Prospect St",
            "city": "Fall River",
            "state": "MA",
            "country_code": "US",
            "postal_code": "027205239",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fall River, MA

Sources for this page

Verify at the official NPI Registry.