Individual provider Active NPI

Diana Lynn Theiss, PH.D., LISW-S

  • Clinical Social Worker
  • Sylvania, OH
National Provider Identifier
1265722813
Registry record updated Mar 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
I-0900183-SUPV Issued in OH
Practice address
5800 Monroe St Ste A1
Sylvania, OH 43560-2208
Phone
(419) 276-3556
NPI assigned
Apr 17, 2011
Last updated
Mar 2, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 2, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X I.0900183-SUPV OH
Clinical Social Worker 1041C0700X I-0900183-SUPV OH Primary

Addresses

Primary practice location

5800 Monroe St Ste A1
Sylvania, OH 43560-2208

Mailing address

5800 Monroe St Ste A1
Sylvania, OH 43560-2208
Phone (419) 276-3556

Other identifiers 1

IdentifierTypeStateIssuer
0155198MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120406000390 OH Practitioner - Clinical Social Worker 1557522141 Receives reassigned benefits from 7 practitioners
Practice locations: Sylvania, OH

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

5800 Monroe St
Suite A1
Sylvania, OH 43560-2208
Phone (419) 276-3556

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
I.0900183-SUPVOHMDSocial Worker
I-0900183-SUPVOHMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Diana L Theiss PHD Clinical CurrentSince Apr 26, 2011 Accepting new patients

Locations

5800 Monroe St
Ste A1
Sylvania, OH 43560
Phone (419) 276-3556

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1302998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677715200000",
    "number": "1265722813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5800 MONROE ST STE A1",
            "city": "SYLVANIA",
            "state": "OH",
            "postal_code": "435602208",
            "telephone_number": "419-276-3556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5800 MONROE ST STE A1",
            "city": "SYLVANIA",
            "state": "OH",
            "postal_code": "435602208",
            "telephone_number": "419-276-3556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEISS",
        "first_name": "DIANA",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "PH.D., LISW-S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-04-17",
        "last_updated": "2023-03-02",
        "certification_date": "2023-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "I.0900183-SUPV",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I-0900183-SUPV",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0155198",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sylvania, OH

Sources for this page

Verify at the official NPI Registry.