NPIMap

Individual provider Active NPI

Tobi N Thaller, MD

  • Family Medicine Physician
  • Raymond, WA
National Provider Identifier
1215355185
Registry record updated Oct 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD60813517 Issued in WA
Practice address
300 Ocean Ave
Raymond, WA 98577-3016
Phone
(360) 942-3040
Fax
(360) 942-3955
NPI assigned
Mar 28, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2024

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 MD60813517 WA Primary

Addresses

Primary practice location

300 Ocean Ave
Raymond, WA 98577-3016

Mailing address

2690 NE Kresky Ave
Chehalis, WA 98532-2412
Phone (360) 330-9595

Other identifiers 1

IdentifierTypeStateIssuer
2093418MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20180112002191 WA Practitioner - Family Practice 5193028835 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Utah School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lewis County Community Health ServicesGroup PAC ID 6002803749, 31 clinicians

Practice addresses (Care Compare)

117 Ramsey Way
Valley View Toledo
Toledo, WA 98591-9900
Phone (360) 864-4400

300 Ocean Ave
Raymond, WA 98577-3016
Phone (360) 942-3040

Hospital & facility affiliations

  • Willapa Harbor Hospital Hospital, South Bend, WA, CCN 501303
  • Grays Harbor Community Hospital Hospital, Aberdeen, WA, CCN 500031
  • Columbia Memorial Hospital Hospital, Astoria, OR, CCN 381320
  • Providence Centralia Hospital Hospital, Centralia, WA, CCN 500019
  • Ocean Beach Hospital Hospital, Ilwaco, WA, CCN 501314

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD60813517WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific County Hospital District 2 CurrentSince Mar 18, 2020 Accepting new patients
Pacific County Hospital District 2 Family Medicine CurrentSince Mar 18, 2020 Accepting new patients
Lewis County Community Health Services Current Accepting new patients
Lewis County Community Health Services CurrentSince Dec 1, 2024 Accepting new patients
Lewis County Community Health Services Past Accepting new patients
Lewis County Community Health Services Past Accepting new patients

Locations

2690 NE Kresky Ave
Chehalis, WA 98532
Phone (360) 330-9595

300 Ocean Ave
Raymond, WA 98577
Phone (360) 942-2303

Interoperability endpoints

  • Direct secure messaging: tobi.thaller.p1@direct.valleyviewhc.nextgenshare.com

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": "1395964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730073600000",
    "number": "1215355185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2690 NE KRESKY AVE",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985322412",
            "telephone_number": "360-330-9595",
            "fax_number": "360-330-9560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 OCEAN AVE",
            "city": "RAYMOND",
            "state": "WA",
            "postal_code": "985773016",
            "telephone_number": "360-942-3040",
            "fax_number": "360-942-3955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THALLER",
        "first_name": "TOBI",
        "middle_name": "N",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-28",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60813517",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2093418",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Raymond, WA

Sources for this page

Verify at the official NPI Registry.