Thana Theofanis, M.D.

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

MD473556 Issued in PA

Practice address

909 Walnut St
Cob 3Rd Floor
Philadelphia, PA 19107-5211

Phone

(215) 955-7008

NPI assigned

Apr 9, 2014

Last updated

Jun 24, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

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

Neurosurgery

Education

Jefferson Medical College of Thomas Jefferson University, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Main Line HealthcareGroup PAC ID 1951215201, 1,154 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Main Line Health Home Care & Hospice - Home Health Home health agency, Radnor, PA, CCN 397012
• Paoli Hospital Hospital, Paoli, PA, CCN 390153
• Bryn Mawr Hospital Hospital, Bryn Mawr, PA, CCN 390139
• Riddle Memorial Hospital Hospital, Media, PA, CCN 390222
• Main Line Hospital Lankenau Hospital, Wynnewood, PA, CCN 390195

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Main Line Healthcare

  • Family Medicine Physician
  • Newtown Square, PA
  • NPI 1922077643

  Neurological Surgery

  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Main Line Hospitals, Inc.

  dba Paoli Hospital

  • General Acute Care Hospital
  • Paoli, PA
  • NPI 1215042114
  Care Compare affiliation
• Main Line Hospitals, Inc.

  dba Lankenau Hospital

  • General Acute Care Hospital
  • Wynnewood, PA
  • NPI 1245335629
  Care Compare affiliation
• Main Line Hospitals, Inc.

  dba Bryn Mawr Hospital

  • General Acute Care Hospital
  • Bryn Mawr, PA
  • NPI 1508971441
  Care Compare affiliation
• Riddle Memorial Hospital

  • General Acute Care Hospital
  • Media, PA
  • NPI 1407856099
  Care Compare affiliation

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

{
    "created_epoch": "1397001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624492800000",
    "number": "1528487329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3803 W CHESTER PIKE STE 160",
            "city": "NEWTOWN SQUARE",
            "state": "PA",
            "postal_code": "190732336",
            "telephone_number": "484-337-1530",
            "fax_number": "484-337-1412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 WALNUT ST",
            "address_2": "COB 3RD FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191075211",
            "telephone_number": "215-955-7008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEOFANIS",
        "first_name": "THANA",
        "name_prefix": "Miss",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-09",
        "last_updated": "2021-06-24",
        "certification_date": "2021-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "PA",
            "license": "MD473556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theodore B Porter, DO, PC
• Nicole Michelle Theodore, REGISTERED NURSE
• Ioannis Theodoropoulos, M.D.
• Nicholas Theodoropoulos, MD
• Georges Theodule, PMHNP-BC
• Therapendence at-Home Rehab LLC
• Therapeutic Alliances LLC
• Therapeutic Center at Fox Chase Aka the Bridge
• Therapeutic Precision LLC
• Therapeutic Waters LLC

• Neurological Surgery Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Neurological Surgery Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 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.