NPIMap

Individual provider Active NPI

Timothy A Theobald, DO

  • Family Medicine Physician
  • Sanford, ME
National Provider Identifier
1104895648
Registry record updated Apr 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
1523 Issued in ME
Practice address
25A June St Ste 111
Sanford, ME 04073-2642
Phone
(207) 490-7998
NPI assigned
Mar 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 1523 ME Primary

Addresses

Primary practice location

25A June St Ste 111
Sanford, ME 04073-2642

Mailing address

1 Medical Center Dr
Biddeford, ME 04005-9422
Phone (207) 282-9080

Other practice location 1

272 Cottage St
Sanford, ME 04073
Phone (207) 490-3405

Other identifiers 1

IdentifierTypeStateIssuer
280450099MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME
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
I20041015000620 ME Practitioner - Family Practice 3577523372 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of New England, College of Osteo Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MainehealthGroup PAC ID 7517860588, 2,616 clinicians

Practice addresses (Care Compare)

22 Bramhall St
Portland, ME 04102-3134
Phone (207) 885-9905

25 A June St
Sanford, ME 04073-2642

Hospital & facility affiliations

  • Mainehealth Home Health and Hospice Home health agency, Saco, ME, CCN 207000
  • Elara Caring Home health agency, South Portland, ME, CCN 207080
  • Centerwell Home Health Home health agency, South Portland, ME, CCN 207038
  • Wentworth Home Care & Hospice, an Amedisys Partner Home health agency, Somersworth, NH, CCN 307014
  • Andwell Health Partners Hospice, Scarborough, ME, CCN 201511
  • Mainehealth Maine Medical Center Hospital, Portland, ME, CCN 200009

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1523MEMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mainehealth Current Accepting new patients
Mainehealth CurrentSince Oct 1, 2018 Accepting new patients
Mainehealth CurrentSince Oct 1, 2018 Accepting new patients
Mainehealth Current Accepting new patients
Mainehealth CurrentSince Jan 1, 2014 Accepting new patients
Webber Hospital Association CurrentSince Jan 1, 2014 Accepting new patients
Goodall Health Partners Past Accepting new patients
Mainehealth Family Medicine Past Accepting new patients

Locations

1 Medical Dr
Biddeford, ME 04005
Phone (207) 283-7000

3 Shape Dr
Kennebunk, ME 04043
Phone (207) 467-8930

22 Bramhall St
Portland, ME 04102
Phone (207) 662-2179

272 Cottage St
Sanford, ME 04073
Phone (207) 324-8888

25A June St
Ste 111
Sanford, ME 04073
Phone (207) 324-5968

25 June St
Sanford, ME 04073
Phone (207) 324-4310

25A June St
Ste 2
Sanford, ME 04073
Phone (207) 324-4643

Interoperability endpoints

  • Direct secure messaging: ttheobald157084@direct.mmc.mainehealth.org

Organizations & group practices 8

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 42

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

View all 42

NPI Registry JSON

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

{
    "created_epoch": "1142467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554076800000",
    "number": "1104895648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER DR",
            "city": "BIDDEFORD",
            "state": "ME",
            "postal_code": "040059422",
            "telephone_number": "207-282-9080",
            "fax_number": "207-459-7609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25A JUNE ST STE 111",
            "city": "SANFORD",
            "state": "ME",
            "postal_code": "040732642",
            "telephone_number": "207-490-7998"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "272 Cottage St",
            "address_purpose": "LOCATION",
            "city": "Sanford",
            "state": "ME",
            "postal_code": "04073",
            "country_code": "US",
            "telephone_number": "207-490-3405",
            "fax_number": "207-324-6275",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THEOBALD",
        "first_name": "TIMOTHY",
        "middle_name": "A",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-16",
        "last_updated": "2019-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ME",
            "license": "1523",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "280450099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sanford, ME

Sources for this page

Verify at the official NPI Registry.