Shane Verl Theobald, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

4938276-4406 Issued in UT

Practice address

151 W 200 N
Vernal, UT 84078-1907

Phone

(435) 781-1519

Fax

(435) 781-1519

NPI assigned

Jun 10, 2008

Last updated

Jun 10, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mountain View Anesthesia LCGroup PAC ID 5991604829, 32 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mountain View Anesthesia LC

  • Anesthesiology Physician
  • Orem, UT
  • NPI 1043249840
  Medicare reassignment Care Compare group NPD
• Riverwoods Anesthesia PLLC

  • Anesthesiology Physician
  • Provo, UT
  • NPI 1821290883
  Medicare reassignment NPD
• Sevier Valley Anesthesia Group, LLP

  • Certified Registered Nurse Anesthetist
  • Richfield, UT
  • NPI 1487895462

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD

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

{
    "created_epoch": "1213056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213056000000",
    "number": "1174783492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 790164",
            "city": "VERNAL",
            "state": "UT",
            "postal_code": "840790164",
            "telephone_number": "435-781-1519",
            "fax_number": "435-781-1519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 W 200 N",
            "city": "VERNAL",
            "state": "UT",
            "postal_code": "840781907",
            "telephone_number": "435-781-1519",
            "fax_number": "435-781-1519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEOBALD",
        "first_name": "SHANE",
        "middle_name": "VERL",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-10",
        "last_updated": "2008-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "UT",
            "license": "4938276-4406",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tarheel OBGYN PC
• Tamarah Leigh Taylor, LCSW
• Tessa Taylor
• The ER Group, LLC
• The Phoenix Recovery & Counseling Center - Vernal
• Tri-County Mental Health and Substance Abuse Local Authority (Northeastern Counseling Center)
• Tricounty Health Department
• Tricounty Health Department
• Tristan Sierra Trout
• True Alliance Counseling, LLC

• Certified Registered Nurse Anesthetist in Vernal, UT
• Providers in Vernal, UT by specialty
• Certified Registered Nurse Anesthetist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.