Physician Compare National (NPI:1457507287)

HEALTHCARE PROVIDER: MARY E THIBERT N.P.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1457507287
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3072670595
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090326000488
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	THIBERT
	Individual professional last name
Provider First Name	MARY
	Individual professional first name
Provider Middle Name	E
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1999
	Individual professional's medical school graduation year
Primary Specialty	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	MICHIGAN KIDNEY CONSULTANTS, P.C.
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	1052207115
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	33
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	22250 PROVIDENCE DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 700
	Group Practice or individual's line 2 address
City	SOUTHFIELD
	Group Practice or individual's city
State	MI
	Group Practice or individual's state
Zip Code	480756215
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2485579010
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	230165
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST JOHN HOSPITAL AND MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	230019
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	PROVIDENCE HOSP AND MED CTRS
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y