NPIMap

Individual provider Active NPI

Robert W Theakston, M.D.

  • General Practice Physician
  • Fort Payne, AL
National Provider Identifier
1255374492
Registry record updated Oct 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
19991 Issued in AL
Practice address
211 Greenhill Blvd NW
Fort Payne, AL 35967-3755
Phone
(256) 845-9355
NPI assigned
Jun 14, 2006
Last updated
Oct 3, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 3, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 19991 AL
General Practice Physician 208D00000X 19991 AL Primary

Addresses

Primary practice location

211 Greenhill Blvd NW
Fort Payne, AL 35967-3755

Mailing address

211 Greenhill Blvd NW
Fort Payne, AL 35967-3755
Phone (256) 845-9355

Other identifiers 1

IdentifierTypeStateIssuer
009932309MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20050826000242 AL Practitioner - General Practice 8426089731 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ess of Eufaula, LLCGroup PAC ID 0840677456, 7 clinicians
Newgen Alabama Billing LLCGroup PAC ID 9133657208, 99 clinicians

Practice addresses (Care Compare)

200 Medical Ctr Dr SW
Fort Payne, AL 35968-3458
Phone (256) 845-3150

211 Greenhill Blvd NW
Fort Payne, AL 35967-3755
Phone (256) 845-9355

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
29.53 of 100Reported as individual
Quality
15
Improvement activities
0
Cost
78.43

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
19991ALMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ess of Eufaula, LLC Emergency Medicine CurrentSince Feb 18, 2024 Accepting new patients
Newgen Alabama Billing LLC Emergency Medicine CurrentSince Sep 4, 2025 Accepting new patients
Northside Medical, Inc. CurrentSince Nov 26, 2008 Accepting new patients
Southern Medical Group, Inc Emergency Medicine Past Accepting new patients
Northside Onsite Medical Services, Inc. Past Accepting new patients
Pine Emergency Group LLC Emergency Medicine Past Accepting new patients

Locations

200 Medical Center Dr SW
Fort Payne, AL 35968
Phone (256) 845-3150

211 Greenhill Blvd NW
Fort Payne, AL 35967
Phone (256) 845-9355

126 Hospital Ave
Ozark, AL 36360
Phone (334) 445-4803

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380758400000",
    "number": "1255374492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 GREENHILL BLVD NW",
            "city": "FORT PAYNE",
            "state": "AL",
            "postal_code": "359673755",
            "telephone_number": "256-845-9355",
            "fax_number": "256-845-7824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 GREENHILL BLVD NW",
            "city": "FORT PAYNE",
            "state": "AL",
            "postal_code": "359673755",
            "telephone_number": "256-845-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEAKSTON",
        "first_name": "ROBERT",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2013-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AL",
            "license": "19991",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "AL",
            "license": "19991",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009932309",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Payne, AL

Sources for this page

Verify at the official NPI Registry.