Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Thalia C Noegroho

Individual provider Behavior Technician · NPI 1598229965

Thalia C Noegroho is a Physician Assistant in Madison, Wisconsin. Qualified in 2022, 4 years ago. Practices with Dean Health Systems Inc, a 1,184-clinician group and accepts Medicare assignment. Licensed in Wisconsin.

Years since qualifying
4
Licensed in
WI
In the registry since
2019
Specialties on file
3
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Practice location Address checks out

700 S Park St Ste A
Madison, WI 53715-1830
Phone: (608) 260-2900
Fax: (608) 260-2976
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5844-23 (WI)
Behavior Technician Taxonomy 106S00000X
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1598229965
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJanuary 29, 2019
Last updated in NPPESSeptember 7, 2022
Certification dateSeptember 7, 2022
Mailing address700 S Park St Ste A, Madison, WI 53715-1830

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Dean Health Systems Inc — 1184 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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