Mary Elsa Theobald, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

R030807 Issued in ME

Practice address

55 Reynolds Road
Brooks, ME 04915

Phone

(207) 722-3488

Fax

(207) 722-3183

NPI assigned

Nov 30, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

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 ME

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mtheobald101168@direct.mmc.mainehealth.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.

• Mainehealth

  dba Mainehealth Behavioral Health

  • Psychiatric Hospital
  • Westbrook, ME
  • NPI 1790265502
  Medicare reassignment NPD
• Mainehealth

  dba MaineHealth Waldo Hospital

  • Critical Access Hospital
  • Belfast, ME
  • NPI 1841397932
  Medicare reassignment NPD
• Mainehealth

  dba MaineHealth Pharmacy Brighton Ave

  • Community/Retail Pharmacy
  • Portland, ME
  • NPI 1013868181
  NPD
• Mainehealth

  • Gynecologic Oncology Physician
  • Scarborough, ME
  • NPI 1851605455
  NPD
• Mainehealth

  dba MaineHealth Primary Care Family Medicine

  • Rural Health Clinic/Center
  • Stockton Springs, ME
  • NPI 1295800118
  NPD (past)
• Mainehealth

  dba MaineHealth Arthur Jewell Health Center

  • Rural Health Clinic/Center
  • Brooks, ME
  • NPI 1487720215
  NPD (past)
• Waldo County General Hospital

  • General Acute Care Hospital
  • Belfast, ME
  • NPI 1295990935
  NPD (past)
• Waldo County General Hospital

  dba Arthur Jewell Health Center Ambulance

  • Ambulance
  • Brooks, ME
  • NPI 1508931429
  NPD (past)

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356418685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 159",
            "city": "BROOKS",
            "state": "ME",
            "postal_code": "049210159",
            "telephone_number": "207-722-3488",
            "fax_number": "207-722-3183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 REYNOLDS ROAD",
            "city": "BROOKS",
            "state": "ME",
            "postal_code": "04915",
            "telephone_number": "207-722-3488",
            "fax_number": "207-722-3183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEOBALD",
        "first_name": "MARY",
        "middle_name": "ELSA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ME",
            "license": "R030807",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julia Ann Mushrall, FNP-C
• John J Pagonis, MD
• Holly Parker, LMT
• Sarina Roche, RN PHD
• Jared Michael Seavey, ACNPC-AG, FNP-C
• Waldo County General Hospital (Arthur Jewell Health Center Ambulance)

• Nurse Practitioner in Brooks, ME
• Providers in Brooks, ME by specialty
• Nurse Practitioner in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.