Individual provider Active NPI

Michael J. Thibodeau, M.D.

  • Internal Medicine Physician
  • Dearborn, MI
National Provider Identifier
1992873434
Registry record updated Mar 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
57585 Issued in MI
Practice address
5500 Auto Club Dr
Dearborn, MI 48126-2779
Phone
(313) 982-8214
NPI assigned
Dec 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 57585 MI Primary

Addresses

Primary practice location

5500 Auto Club Dr
Dearborn, MI 48126-2779

Mailing address

5500 Auto Club Dr
Dearborn, MI 48126-2779
Phone (313) 982-8214

Other practice location 1

2799 W Grand Blvd
Detroit, MI 48202-2608
Phone (313) 916-2600

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mthibod12941@direct.hfhs.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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

Enrollment IDStateProvider typePAC IDDetails
I20100615000658 MI Practitioner - Internal Medicine 7618007824 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Wayne State University School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Henry Ford Health SystemGroup PAC ID 0547178311, 2,550 clinicians

Practice addresses (Care Compare)

1 Ford PL
Detroit, MI 48202-3450
Phone (313) 874-6677

2799 W Grand Blvd
Detroit, MI 48202-2608

5500 Auto Club Dr
Dearborn, MI 48126-2779
Phone (313) 425-4500

Hospital & facility affiliations

  • Henry Ford Home Health Care Home health agency, Detroit, MI, CCN 237087
  • Henry Ford Health Hospital Hospital, Detroit, MI, CCN 230053
  • Henry Ford Health West Bloomfield Hospital Hospital, W Bloomfield, MI, CCN 230302
  • Wyandotte Hospital and Medical Center Hospital, Wyandotte, MI, CCN 230146

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
57585MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health System Current Accepting new patients
Henry Ford Health System Internal Medicine CurrentSince Jan 1, 1994 Accepting new patients
Henry Ford Health System CurrentSince Jan 1, 1994 Accepting new patients

Locations

19401 Hubbard Dr
Dearborn, MI 48126
Phone (313) 982-8100

1 Ford Pl
#2E
Detroit, MI 48202
Phone (313) 874-4688

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

Interoperability endpoints

  • Direct secure messaging: mthibodeau12941@direct.hfhs.org

Organizations & group practices 3

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616544000000",
    "number": "1992873434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 AUTO CLUB DR",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481262779",
            "telephone_number": "313-982-8214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5500 AUTO CLUB DR",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481262779",
            "telephone_number": "313-982-8214"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2799 W Grand Blvd",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482022608",
            "country_code": "US",
            "telephone_number": "313-916-2600",
            "fax_number": "313-916-3235",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THIBODEAU",
        "first_name": "MICHAEL",
        "middle_name": "J.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-01",
        "last_updated": "2021-03-24",
        "certification_date": "2021-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "57585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mthibod12941@direct.hfhs.org",
            "affiliation": "N",
            "address_1": "5500 Auto Club Dr",
            "city": "Dearborn",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481262779",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

Verify at the official NPI Registry.