Robert James Theobald III, DO

Primary specialty

Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X

License

OS9540 Issued in FL

Practice address

14547 Bruce B Downs Blvd
Suite B
Tampa, FL 33613-2709

Phone

(813) 875-2600

Fax

(813) 875-2626

NPI assigned

Jul 7, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

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

Colorectal Surgery (Proctology)

Education

At Still University of Health Sciences, College of Osteo Med, Kirksville, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ohi West Medical Group II LLCGroup PAC ID 0648631192, 407 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

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.

• Ohi West Medical Group II LLC

  • General Practice Physician
  • Zephyrhills, FL
  • NPI 1982381299
  Medicare reassignment Care Compare group NPD
• Florida Medical Clinic LLC

  • Clinic/Center
  • Zephyrhills, FL
  • NPI 1821055690
  Medicare reassignment NPD
• Vein Associates, PA

  • Phlebology Physician
  • Heathrow, FL
  • NPI 1326076902
  NPD (past) Authorized official
• Florida Medical Clinic, LLC

  • Pharmacy
  • Zephyrhills, FL
  • NPI 1669548020
  NPD
• Ohi West Medical Group II LLC

  • Durable Medical Equipment & Medical Supplies
  • Wesley Chapel, FL
  • NPI 1427814847
  NPD
• Ohi West Medical Group II LLC

  • Physiological Laboratory
  • Zephyrhills, FL
  • NPI 1679344394
  NPD (past)
• Kelly D. Burchett DO LLC

  • Otolaryngology/Facial Plastic Surgery Physician
  • Kirksville, MO
  • NPI 1891983037
  NPD (past)

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630022400000",
    "number": "1396778239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38135 MARKET SQ",
            "city": "ZEPHYRHILLS",
            "state": "FL",
            "postal_code": "335427505",
            "telephone_number": "813-780-1255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14547 BRUCE B DOWNS BLVD",
            "address_2": "SUITE B",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336132709",
            "telephone_number": "813-875-2600",
            "fax_number": "813-875-2626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEOBALD",
        "first_name": "ROBERT",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "FL",
            "license": "OS9540",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01095109",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "protocology@flmed.directbygreenway.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "14547 Bruce B Downs Blvd",
            "address_2": "Suite B",
            "city": "Tampa",
            "state": "FL",
            "country_code": "US",
            "postal_code": "336132709",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Deztiny Theirse
• Alexandra Thelan, PHD
• Remington Thele, RN
• Camille Suzanne Thelin, M.D.
• Janeen M Theobald, ARNP
• Theodore Edward David Peters, DDS,PA
• Margaret Theodore, M.D.
• Dorothy Theogene, DDS
• Christine Theophilopoulos, CRNA
• Therakids Plus Center for Children & Adults

• Colon & Rectal Surgery Physician in Tampa, FL
• Providers in Tampa, FL by specialty
• Colon & Rectal Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 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.