Thaddaeus M Vaichus

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1235705 Issued in OH

Practice address

4881 Sugar Maple Dr
Wright Patterson AFB, OH 45433-5529

Phone

(937) 257-5523

NPI assigned

Jul 19, 2024

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

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

State licenses

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

{
    "created_epoch": "1721347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742860800000",
    "number": "1770321937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 BOATNER RD",
            "city": "EGLIN AFB",
            "state": "FL",
            "postal_code": "325421302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4881 SUGAR MAPLE DR",
            "city": "WRIGHT PATTERSON AFB",
            "state": "OH",
            "postal_code": "454335529",
            "telephone_number": "937-257-5523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAICHUS",
        "first_name": "THADDAEUS",
        "middle_name": "M",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-07-19",
        "last_updated": "2025-03-25",
        "certification_date": "2025-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "1235705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Lee Traver, O.D.
• Christopher Makoto Tsueda, M.D.
• Anthony Paul Tvaryanas, M.D., P.H.D., M.P.H.
• United States Air Force
• United States Air Force
• William Joseph Valko, M.D.
• Richard E Vanarsdel, O.D.
• Anna M Vance, CRNA
• Richard Isaac Vance, DMD
• Patrick Vancura

• Physician Assistant in Wright Patterson AFB, OH
• Providers in Wright Patterson AFB, OH by specialty
• Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2025; 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.