Active NPI
Omer Thibodeau, M.D.
- Surgery Physician
- Biddeford, ME
National Provider Identifier
1699811406
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 7706
- Practice address
- 3 Medical Center Dr
Biddeford, ME 04005-9422 - Phone
- (207) 284-4597
- NPI assigned
- Jan 29, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 7706 | ME | |
| Surgery Physician | 208600000X | 7706 | ME | Primary |
Addresses
Primary practice location
3 Medical Center Dr
Biddeford, ME 04005-9422
Mailing address
9 Healthcare Dr
Biddeford, ME 04005-9449
Phone (207) 282-9080
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01 0398532 | Other | ME | TRICARE |
| 114440099 | Medicaid | ME | |
| B86995 | Other | ME | HARVARD PILGRIM |
| 01 0398532 | Other | ME | CIGNA |
| 30207619 | Medicaid | NH | |
| 1041542 | Other | ME | AETNA |
| 114440000 | Medicaid | ME |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7706 | ME | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1256601600000",
"number": "1699811406",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9 HEALTHCARE DR",
"city": "BIDDEFORD",
"state": "ME",
"postal_code": "040059449",
"telephone_number": "207-282-9080",
"fax_number": "207-282-9080"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 MEDICAL CENTER DR",
"city": "BIDDEFORD",
"state": "ME",
"postal_code": "040059422",
"telephone_number": "207-284-4597"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THIBODEAU",
"first_name": "OMER",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-29",
"last_updated": "2009-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "ME",
"license": "7706",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "ME",
"license": "7706",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "01 0398532",
"state": "ME"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "114440099",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM",
"identifier": "B86995",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "01 0398532",
"state": "ME"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30207619",
"state": "NH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "1041542",
"state": "ME"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "114440000",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Biddeford, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.