Simone Rose Thibault
Individual provider Active NPI Obstetrics & Gynecology Physician · Beaverton, OR
NPI 1700535663 · NPPES record last updated Aug 11, 2026
Key facts
- NPI
- 1700535663
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- MD231429 (OR)
- Practice address
- 4855 SW Western Ave
Beaverton, OR 97005-3460 - Phone
- (503) 813-2000
- NPI assigned
- Mar 19, 2022
- Sex
- Female
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Obstetrics/Gynecology
- Education
- Other, 2022
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
10850 White Rock Rd
Rancho Cordova, CA 95670-6044
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230517002761 | CA | Order and Referring Only - Obstetrics/Gynecology |
4981060993 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician |
207V00000X | MD231429 | OR | Yes |
Addresses
Primary practice location
4855 SW Western Ave
Beaverton, OR 97005-3460
Mailing address
4855 SW Western Ave
Beaverton, OR 97005-3460
Phone (503) 813-2000
Other providers in Beaverton, OR
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- Therapy Centers of the Southwest I, P.a., P.C.
- Vanessa Nicole Therson
- Korey Thieleke
- Thinkbig, LLC, PSC
- Jenny Thom
- Thomas D Gilberts MD LLC
- Thomas Family Dentistry
All providers in Beaverton, OR · Obstetrics & Gynecology Physician in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 11, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.