Caryn Theobald, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

35-082516 Issued in OH

Practice address

3926 New Vision Dr
Fort Wayne, IN 46845-1712

Phone

(419) 445-2015

Fax

(419) 445-8102

NPI assigned

Jun 21, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: caryn.theobald.1@14940.direct.athenahealth.com

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.

• Lima Memorial Joint Operating Company

  dba Lima Memorial Health System

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484179200000",
    "number": "1396781233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "442 W HIGH ST",
            "city": "BRYAN",
            "state": "OH",
            "postal_code": "435061681",
            "telephone_number": "419-636-4517",
            "fax_number": "419-636-6438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3926 NEW VISION DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451712",
            "telephone_number": "419-445-2015",
            "fax_number": "419-445-8102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEOBALD",
        "first_name": "CARYN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-21",
        "last_updated": "2017-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35-082516",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "P00245754",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2432264",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• The Mental Health Clinic LLC
• The Samaritan Centers of Northeast Indiana, Inc
• The Shel Stitch Company LLC
• The Waters of Fort Wayne Skilled Nursing Facility LLC
• Randi Theising
• Therapeutic Mobility Services Inc
• Therapy Link Group, LLC
• Therapy Link LLC
• Therese C Mihlbauer, PH.D., Inc
• Timothy Theye, LCSW, LMHC, LCAC

• Family Medicine Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.