Roberta Jo Theis, MSE

Primary specialty

PsychologistTaxonomy code 103T00000X

License

LP1134 Issued in MN

Practice address

Roberta J Theis
8010 60TH Ave. North
Minneapolis, MN 55428

Phone

(763) 208-3784

Fax

(763) 208-3784

NPI assigned

Jan 22, 2007

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

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554249600000",
    "number": "1609920164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ROBERTA J THEIS",
            "address_2": "8010 60TH AVE. NORTH",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55428",
            "telephone_number": "763-208-3784",
            "fax_number": "763-208-3784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ROBERTA J THEIS",
            "address_2": "8010 60TH AVE. NORTH",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55428",
            "telephone_number": "763-208-3784",
            "fax_number": "763-208-3784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEIS",
        "first_name": "ROBERTA",
        "middle_name": "JO",
        "name_prefix": "Ms.",
        "credential": "MSE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-22",
        "last_updated": "2019-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "08691",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP1134",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "622252800",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL BLUE CROSS BLU",
            "identifier": "40G40TH",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP BLUE CROSS BLUE SHI",
            "identifier": "40G39TH",
            "state": "MH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• The Women'S Retreat Center
• Kylie Thedens, RN
• Jennifer Lynn Theis, MSOT
• Jennifer R Theis, RN
• Katrina Theis, M.A.
• Brian James Theisen, PT, DPT, ATC
• Calandra D Theisen, DPM
• Jacqueline Theisen, MD, MPH
• James Jenkins Theisen, PH.D., LP
• Jay Lee Theisen, MSW LICSW

• Psychologist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2019; 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.