Active NPI
Evan B Theobald, CRNA
- Certified Registered Nurse Anesthetist
- Payson, UT
National Provider Identifier
1497859037
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 375417-4406
- Practice address
- 1000 E 100 N
Payson, UT 84651-1600 - Phone
- (800) 748-4868
- Fax
- (801) 733-5872
- NPI assigned
- Sep 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 375417-4406 | UT | Primary |
Addresses
Primary practice location
1000 E 100 N
Payson, UT 84651-1600
Mailing address
32 W 1320 S
Payson, UT 84651-3012
Phone (801) 465-3844
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 34456 | Other | UT | HEALTHY U |
| 894814 | Other | UT | DESERET MUTUAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 375417-4406 | UT | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1497859037",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "32 W 1320 S",
"city": "PAYSON",
"state": "UT",
"postal_code": "846513012",
"telephone_number": "801-465-3844"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 E 100 N",
"city": "PAYSON",
"state": "UT",
"postal_code": "846511600",
"telephone_number": "800-748-4868",
"fax_number": "801-733-5872"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THEOBALD",
"first_name": "EVAN",
"middle_name": "B",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "UT",
"license": "375417-4406",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHY U",
"identifier": "34456",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DESERET MUTUAL",
"identifier": "894814",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Payson, UT
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.