S Michelle Thornblade, PA C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

C0002969 Issued in MD

Practice address

3975 Saint Charles Pkwy
Waldorf, MD 20602-2683

Phone

(301) 645-6800

Fax

(301) 645-8696

NPI assigned

Aug 2, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• S Michelle Westphal Former name

Medicare fee-for-service enrollment

Enrolled in MT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts, Physician Assistant

State licenses

Practice roles

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.

• Carl Thornblade, MD, PLLC

  • Allergy & Immunology Physician
  • Missoula, MT
  • NPI 1750557690
  Medicare reassignment
• Intermountain Planned Parenthood Inc

  • Non-Surgical Family Planning Clinic/Center
  • Billings, MT
  • NPI 1134297179
  Medicare reassignment
• Planned Parenthood of Maryland, Inc.

  • Ambulatory Family Planning Facility
  • Baltimore, MD
  • NPI 1235242082
  NPD (past)
• Premier OBGYN

  • Specialist
  • Bowie, MD
  • NPI 1548405020
  NPD (past)
• Community Medicine Associates

  • Family Medicine Physician
  • San Antonio, TX
  • NPI 1245313329

  Physician Assistant

  NPD (past)
• Frances Mahon Deaconess Hospital

  • Critical Access Hospital
  • Glasgow, MT
  • NPI 1689685323
  NPD (past)

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

{
    "created_epoch": "1122940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1629079454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 N HOWARD ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212013610",
            "telephone_number": "410-576-1400",
            "fax_number": "410-576-7600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3975 SAINT CHARLES PKWY",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206022683",
            "telephone_number": "301-645-6800",
            "fax_number": "301-645-8696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THORNBLADE",
        "first_name": "S",
        "middle_name": "MICHELLE",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0002969",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE (EXPIRED)",
            "identifier": "1421",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA LICENSE (INACTIVE STAT",
            "identifier": "PA02088",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "S",
            "last_name": "WESTPHAL",
            "middle_name": "MICHELLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Shawnee Lakai Thomas, CRNP
• Valerie Thomas, P.A.
• Christina Thomopoulos
• Mollie Miller Thorn, L.C.P.C.
• Philip Andrew Thorn, L.C.P.C.
• Anna Paul Thottan, MD
• Thoughtful Therapeutips, LLC.
• Three Angels Assisted Living LLC
• Besi Long Tong, DMD, MSD
• Toothsome Dental

• Physician Assistant in Waldorf, MD
• Providers in Waldorf, MD by specialty
• Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.