Jean-Etienne Thibaud, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

224277 Issued in NY

Practice address

1713-19 Ralph Ave
Brooklyn, NY 11236

Phone

(718) 531-6100

Fax

(718) 531-2329

NPI assigned

Aug 16, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

New York College of Osteo Medicine of New York Institute of Technology, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Doral Medical and Multi Specialty Facility LLCGroup PAC ID 9830528645, 53 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H9678

Interoperability endpoints

• Direct secure messaging: jthibaud1127348@nychhc.direct-ci.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.

• Doral Medical and Multi Specialty Facility LLC

  • Multi-Specialty Clinic/Center
  • Brooklyn, NY
  • NPI 1144693607
  Medicare reassignment Care Compare group NPD
• Faith Family Medical PC

  • Family Medicine Physician
  • Brooklyn, NY
  • NPI 1598878167
  NPD (past) Authorized official
• Doral Pharmacy LLC

  • Community/Retail Pharmacy
  • Brooklyn, NY
  • NPI 1558051482
  NPD (past)
• PPG Anesthesia, PLLC

  • Anesthesiology Physician
  • Staten Island, NY
  • NPI 1740430727
  NPD (past)

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214956800000",
    "number": "1871606442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100714",
            "address_2": "VANDERVEER STATION",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112100714",
            "telephone_number": "718-531-6100",
            "fax_number": "718-531-2329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1713-19 RALPH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11236",
            "telephone_number": "718-531-6100",
            "fax_number": "718-531-2329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIBAUD",
        "first_name": "JEAN-ETIENNE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-16",
        "last_updated": "2008-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "224277",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00695941",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02366750",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Darline Theus
• Justina Theus, RPH
• Stephania Thevenot, LPN
• Jamuna Theventhiran
• Joanne Theverin
• Marie Thibaud
• Rachel Thibodeau, DO
• Aye Mon Thida, MD
• Rosemonde Marie de L'Esperance Thieba, REGISTER NURSE
• Spencer Thiel, MD

• Family Medicine Physician in Brooklyn, NY
• Providers in Brooklyn, 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 2, 2008; 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.