Active NPI
Teresa Yvonne Thacker, MD
- Family Medicine Physician
- Lexington, VA
National Provider Identifier
1891875274
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 0101047078
- Practice address
- 108 Houston St
Lexington, VA 24450-2455 - Phone
- (540) 463-7628
- NPI assigned
- Oct 17, 2006
- Last updated
- Aug 6, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 0101047078 | VA | Primary |
Addresses
Primary practice location
108 Houston St
Lexington, VA 24450-2455
Mailing address
213 S Jefferson St Ste 1006
Roanoke, VA 24011-1713
Phone (540) 224-5352
Other practice location 1
1155 Main St
Milton, WV 25541-1217
Phone (304) 743-8833
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0053757000 | Medicaid | WV | |
| 001721893 | Other | WV | BCBS |
| 080174378 | Other | WV | TRAVLERS MEDICARE |
Other names 1
- Dr. Teresa Yvonne Thacker
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV, TX, VA, HI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 4
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Other, 1990
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
4590 Hana Hwy
Hana, HI 96713
Phone (808) 248-8294
469 Emily Dr
Clarksburg, WV 26301-5512
Phone (304) 423-5180
Highway 191 and Hospital Rd
Chinle, AZ 86503-8000
Phone 92867470307030
P O Box
Hana, HI 96713-0807
PO Box
Hana, HI 96713
PO Box PH
Chinle, AZ 86503-8000
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101047078 | VA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tug River Health Association, Inc | Current | Accepting new patients | |
| DHHS PHS Naihs Chinle Comprehensive Health Care Facility | Current | Accepting new patients | |
| St. Mary's Himg, LLC | Family Medicine | Past | Accepting new patients |
Interoperability endpoints
- teresa.thacker.1@18068.direct.athenahealth.com
Organizations & group practices 6
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Chinle Comprehensive Health Care Facility
- General Acute Care Hospital
- Chinle, AZ
- NPI 1508800129
TX
-
- Federally Qualified Health Center (FQHC)
- Hana, HI
- NPI 1992811954
-
- Family Medicine Physician
- Shinnston, WV
- NPI 1184849200
-
- Federally Qualified Health Center (FQHC)
- Gary, WV
- NPI 1174501068
-
dba Pinon Health Center
- General Acute Care Hospital
- Pinon, AZ
- NPI 1396761565
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Bridgeport, WV
- NPI 1184606600
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722902400000",
"number": "1891875274",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "213 S JEFFERSON ST STE 1006",
"city": "ROANOKE",
"state": "VA",
"postal_code": "240111713",
"telephone_number": "540-224-5352"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "108 HOUSTON ST",
"city": "LEXINGTON",
"state": "VA",
"postal_code": "244502455",
"telephone_number": "540-463-7628"
}
],
"practiceLocations": [
{
"address_1": "1155 Main St",
"address_purpose": "LOCATION",
"city": "Milton",
"state": "WV",
"postal_code": "255411217",
"country_code": "US",
"telephone_number": "304-743-8833",
"fax_number": "304-743-8834",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "THACKER",
"first_name": "TERESA",
"middle_name": "YVONNE",
"name_prefix": "Mrs.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-17",
"last_updated": "2024-08-06",
"certification_date": "2024-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "VA",
"license": "0101047078",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0053757000",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "001721893",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRAVLERS MEDICARE",
"identifier": "080174378",
"state": "WV"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "TERESA",
"last_name": "THACKER",
"middle_name": "YVONNE",
"prefix": "DR.",
"credential": "MD",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Lexington, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2024; 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.