NPIMap

Individual provider Active NPI

Theodore Raymond Pacheco, M.D.

  • Cardiovascular Disease Physician
  • Lorain, OH
National Provider Identifier
1023097201
Registry record updated Jan 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
35065306 Issued in OH
Practice address
3600 Kolbe Rd
Suite 127
Lorain, OH 44053-1654
Phone
(440) 414-9200
Fax
(216) 201-5582
NPI assigned
Jan 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 35065306 OH Primary

Addresses

Primary practice location

3600 Kolbe Rd
Suite 127
Lorain, OH 44053-1654

Mailing address

3600 Kolbe Rd
Suite 127
Lorain, OH 44053-1654
Phone (440) 414-9200

Other identifiers 6

IdentifierTypeStateIssuer
341221800068OtherOHCARESOURCE
000000128727OtherOHANTHEM
E65306OtherOHSUMMACARE
0972863MedicaidOH
100399OtherOHKAISER
060023253OtherRAILROAD MEDICARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address theodorepacheco@nohomg.allscriptsdirect.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040511000976 OH Practitioner - Cardiovascular Disease (Cardiology) 1456258334 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Creighton University School of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

125 E Broad St
Suite 218
Elyria, OH 44035-6447
Phone (440) 329-7310

158 W Main Rd
Conneaut, OH 44030-2039

29325 Health Campus Dr
Westlake, OH 44145-8201

32800 Lorain Rd
North Ridgeville, OH 44039-3430

630 E River St
Elyria, OH 44035-5902
Phone (440) 329-7500

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35065306OHMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Primary Care Practices Inc CurrentSince Oct 1, 2021 Accepting new patients
University Primary Care Practices Inc Cardiovascular Disease CurrentSince Oct 1, 2021 Accepting new patients
Mercy Health-Regional Medical Center LLC Cardiovascular Disease CurrentSince Jan 1, 2003 Accepting new patients
University Primary Care Practices Inc Current Accepting new patients
Mercy Health-Regional Medical Center LLC CurrentSince Jan 1, 2003 Accepting new patients
University Primary Care Practices Past Accepting new patients

Locations

158 W Main Rd
Ste 203
Conneaut, OH 44030
Phone (440) 285-2960

3700 Kolbe Rd
Lorain, OH 44053
Phone (440) 331-9520

3600 Kolbe Rd
Ste 127
Lorain, OH 44053
Phone (440) 414-9200

32800 Lorain Rd
Ste 1100
North Ridgeville, OH 44039
Phone (440) 329-2810

29325 Health Campus Dr
Ste 3
Westlake, OH 44145
Phone (440) 414-9400

Interoperability endpoints

  • Direct secure messaging: tpacheco37298@ehrdirect.uhhospitals.org

Organizations & group practices 6

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 9

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": "1137369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609977600000",
    "number": "1023097201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 KOLBE RD",
            "address_2": "SUITE 127",
            "city": "LORAIN",
            "state": "OH",
            "postal_code": "440531654",
            "telephone_number": "440-414-9200",
            "fax_number": "216-201-5582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 KOLBE RD",
            "address_2": "SUITE 127",
            "city": "LORAIN",
            "state": "OH",
            "postal_code": "440531654",
            "telephone_number": "440-414-9200",
            "fax_number": "216-201-5582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACHECO",
        "first_name": "THEODORE",
        "middle_name": "RAYMOND",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-16",
        "last_updated": "2021-01-07",
        "certification_date": "2021-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "OH",
            "license": "35065306",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARESOURCE",
            "identifier": "341221800068",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000128727",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUMMACARE",
            "identifier": "E65306",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0972863",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KAISER",
            "identifier": "100399",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "060023253",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "theodorepacheco@nohomg.allscriptsdirect.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3600 Kolbe Rd",
            "address_2": "suite 127",
            "city": "Lorain",
            "state": "OH",
            "country_code": "US",
            "postal_code": "440531654",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lorain, OH

Sources for this page

Verify at the official NPI Registry.