ALISA THAVIKULWAT
NPI 1265827745
Ophthalmology in Glenn Dale, MD
About Alisa Thavikulwat NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ALISA THAVIKULWAT (NPI 1265827745) is an individual ophthalmology provider in Glenn Dale, Maryland, licensed in Maryland (D0087217) and active in the NPI registry since April 2015. She is enrolled in Medicare PECOS and is a graduate of University Of Rochester School Of Medicine And Dentistry (2015).
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Alisa Thavikulwat is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignment
Medicare enrollment records show Alisa Thavikulwat reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Glenn Dale, MD 20769
- Reassigned Medicare billing, District of Columbia enrollment
- 6 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims 14
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 20769 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Alisa Thavikulwat's NPI number?
The NPI number for Alisa Thavikulwat is 1265827745. It was assigned to this individual provider in the NPPES registry on April 1, 2015.
Where is Alisa Thavikulwat located?
Alisa Thavikulwat practices at 12150 Annapolis Rd Ste 111, Glenn Dale, MD 20769. The listed phone number is (301) 779-0844.
What is Alisa Thavikulwat's specialty?
The primary specialty registered for this NPI is Ophthalmology with taxonomy code 207W00000X.
Is Alisa Thavikulwat enrolled in Medicare?
Yes. Alisa Thavikulwat is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Alisa Thavikulwat's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Alisa Thavikulwat reassigns Medicare benefits to Visionmd, LLC (Glenn Dale, MD). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Alisa Thavikulwat's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Alisa Thavikulwat accept?
Health plans from Blue Cross Blue Shield of Wyoming and Blue Cross and Blue Shield of Louisiana list Alisa Thavikulwat as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Alisa Thavikulwat was last updated on September 24, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Alisa Thavikulwat · NPI 1265827745
Ophthalmology physician in Glenn Dale, Maryland. Individual provider, active in the CMS NPPES registry since April 1, 2015.
## Identity
- **NPI:** 1265827745 (Entity type: Individual)
- **Enumerated:** April 1, 2015
- **Primary specialty:** Ophthalmology · taxonomy 207W00000X
- **State license:** D0087217 (Maryland)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 12150 ANNAPOLIS RD STE 111, Glenn Dale, MD 20769-9183
- **Phone:** (301) 779-0844
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Visionmd, LLC (NPI 1801381884, Glenn Dale, MD), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** University Of Rochester School Of Medicine And Dentistry, class of 2015
## Record status
- **NPPES last updated:** September 24, 2020
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Source: [NPI Profile](https://npiprofile.com/npi/1265827745) · Data from the CMS NPPES public registry.