John Willaim Thousand IV, D.D.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

00201869 Issued in CO

Practice address

3 Cypress Branch Way
Palm Coast, FL 32164-8409

Phone

(386) 445-4247

NPI assigned

Apr 20, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Apr 4, 2024 through Apr 4, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jthousand744086@direct.shands.ufl.edu

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.

• Florida Sedation, Implant and Dental Surgery Associates, LLC

  • Periodontics
  • Saint Augustine, FL
  • NPI 1932623733
  NPD (past) Authorized official

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

{
    "created_epoch": "1429488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456358400000",
    "number": "1972990752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "980 WINDWARD WAY",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320806182",
            "telephone_number": "303-250-4091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 CYPRESS BRANCH WAY",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321648409",
            "telephone_number": "386-445-4247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOUSAND",
        "first_name": "JOHN",
        "middle_name": "WILLAIM",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-20",
        "last_updated": "2016-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CO",
            "license": "00201869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lorraine Thompson
• Whitney Thorne, D.O.
• Kevin Robert Thorpe, D.C.
• Sanjana Thota-Kammili, MBBS
• Venkata Ram Prasad Thota, M.D.
• Thrive PT & Wellness LLC
• Tigris Rivers
• Katherine Love Timlin, SLP
• Luciane Timoteo, RN
• Timothy W Valk MD PA

• Periodontics in Palm Coast, FL
• Providers in Palm Coast, FL by specialty
• Periodontics in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.