Ephraim Isaac Thaller

Primary specialty

Allergy & Immunology PhysicianTaxonomy code 207K00000X

License

L4144 Issued in TX

Practice address

333 Londonderry Dr
Suite 100
Waco, TX 76712-7900

Phone

(254) 751-1144

Fax

(254) 751-1185

NPI assigned

May 23, 2006

Last updated

Dec 27, 2021By 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 2

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Allergy/ImmunologyAlso: Pediatric Medicine

Education

Texas a & M University System, HSC, College of Medicine, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Allergy and Asthma Center PAGroup PAC ID 6507885902, 3 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ethaller62644@direct.sw.org

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.

• Allergy & Asthma Center PA

  • Allergy Physician
  • Waco, TX
  • NPI 1124125117
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640563200000",
    "number": "1245285022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 LONDONDERRY DR",
            "address_2": "SUITE 100",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767127900",
            "telephone_number": "254-751-1144",
            "fax_number": "254-751-1185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 LONDONDERRY DR",
            "address_2": "SUITE 100",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767127900",
            "telephone_number": "254-751-1144",
            "fax_number": "254-751-1185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THALLER",
        "first_name": "EPHRAIM",
        "middle_name": "ISAAC",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2021-12-27",
        "certification_date": "2021-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "TX",
            "license": "L4144",
            "primary": true
        },
        {
            "code": "207KA0200X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Allergy",
            "state": "TX",
            "license": "L4144",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "00712N",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST CARE",
            "identifier": "151825100",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "180355301",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00428353",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8V9670",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Katherine Elizabeth Thaller, M.D.
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• David Fay Tharp, PSY.D.
• Courtney Marie Thatcher

• Allergy & Immunology Physician in Waco, TX
• Providers in Waco, TX by specialty
• Allergy & Immunology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.