Individual provider Active NPI

Christine W Thurston, D. O

  • Internal Medicine Physician
  • Mandeville, LA
National Provider Identifier
1700173556
Registry record updated Oct 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
323614 Issued in LA
Practice address
201 Saint Ann Dr Ste B
Mandeville, LA 70471-3472
Phone
(985) 626-1717
NPI assigned
Jun 30, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 7, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 323614 LA Primary

Addresses

Primary practice location

201 Saint Ann Dr Ste B
Mandeville, LA 70471-3472

Mailing address

201 Saint Ann Dr Ste B
Mandeville, LA 70471-3472
Phone (985) 626-1717

Other identifiers 1

IdentifierTypeStateIssuer
323614OtherLALA LICENSE

Other names 1

  • Christine Elizabeth Whitehead Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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

Enrollment IDStateProvider typePAC IDDetails
I20201014000413 LA Practitioner - Internal Medicine 0840447900 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

201 Saint Ann Dr B
Mandeville, LA 70471-3219
Phone (985) 626-1717

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
323614LAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Tammany Parish Hospital Service District No 1 Internal Medicine CurrentSince Oct 1, 2020 Accepting new patients
St. Tammany Parish Hospital Service District No 1 Past Accepting new patients

Locations

1202 S Tyler St
Covington, LA 70433
Phone (985) 898-3743

1520 Highway 22 W
Madisonville, LA 70447
Phone (985) 773-1600

201 Saint Ann Dr
Ste B
Mandeville, LA 70471
Phone (985) 626-1717

Organizations & group practices 2

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1309392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602028800000",
    "number": "1700173556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 SAINT ANN DR STE B",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704713472",
            "telephone_number": "985-626-1717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 SAINT ANN DR STE B",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704713472",
            "telephone_number": "985-626-1717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THURSTON",
        "first_name": "CHRISTINE",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "D. O",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-30",
        "last_updated": "2020-10-07",
        "certification_date": "2020-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "323614",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LA LICENSE",
            "identifier": "323614",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHRISTINE",
            "last_name": "WHITEHEAD",
            "middle_name": "ELIZABETH",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mandeville, LA

Sources for this page

Verify at the official NPI Registry.