Glenn F Thibault, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

220472 Issued in NY

Practice address

61 Delano St
Pulaski, NY 13142-1400

Phone

(315) 298-6564

Fax

(315) 298-7488

NPI assigned

Sep 8, 2005

Sex

Male

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 3

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

Family Practice

Education

Uniformed Services Uhs Fe Hebert School of Med, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northern Oswego County Health Services, Inc.Group PAC ID 8426961541, 37 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Centerwell Home Health Home health agency, Liverpool, NY, CCN 337255
• Hospice of Central New York Hospice, Liverpool, NY, CCN 331511
• Oswego Hospital Hospital, Oswego, NY, CCN 330218

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: glenn.thibault@nochsi.directbygreenway.com

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.

• Northern Oswego County Health Services, Inc.

  dba ConnextCare

  • Community Health Clinic/Center
  • Pulaski, NY
  • NPI 1508850280
  Medicare reassignment Care Compare group NPD

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

• Oswego Hospital

  • General Acute Care Hospital
  • Oswego, NY
  • NPI 1871678458
  Care Compare affiliation
• QC-Medi New York, Inc.

  dba CenterWell Home Health

  • Home Health Agency
  • Syracuse, NY
  • NPI 1912939489
  Care Compare affiliation
• The Caring Coalition of Central New York

  dba Hospice of Central New York

  • Community Based Hospice Care Agency
  • Liverpool, NY
  • NPI 1912098666
  Care Compare affiliation

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

{
    "created_epoch": "1126137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1699769364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61 DELANO ST",
            "city": "PULASKI",
            "state": "NY",
            "postal_code": "131421400",
            "telephone_number": "315-298-6564",
            "fax_number": "315-298-7488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61 DELANO ST",
            "city": "PULASKI",
            "state": "NY",
            "postal_code": "131421400",
            "telephone_number": "315-298-6564",
            "fax_number": "315-298-7488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIBAULT",
        "first_name": "GLENN",
        "middle_name": "F",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-08",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "220472",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00220472",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FQHC NUMBER",
            "identifier": "331880",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00307662",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Raymond Edward Stark, RN
• Aubryn Stelmashuck, FNP
• Jay Frederick Sullivan, MD
• Marissa L Taber, RDH
• Samantha Taber
• Thomas Patrick McCue IV DDS PC (McCue Dntal)
• Linda Kuhns Troia, PA, LCSW
• Walgreen Co (Walgreens #19496)
• Amy Waterman-Albrecht, MHC
• Betsy B Waterman, PHD

• Family Medicine Physician in Pulaski, NY
• Providers in Pulaski, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.