Theodore Raymond Matheny, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD00040536 Issued in WA

Practice address

617 Dayton St Ste 2
#A
Edmonds, WA 98020-3446

Phone

(425) 776-3399

Fax

(425) 776-5511

NPI assigned

Oct 2, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective May 19, 2020 through May 19, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: theom@direct.forkshospital.org

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.

• Clallam County Public Hospital District No 1

  dba Forks Community Hospital

  • Critical Access Hospital
  • Forks, WA
  • NPI 1891879680
  NPD

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266278400000",
    "number": "1619060530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "617 DAYTON ST STE 2",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980203446",
            "telephone_number": "425-776-3399",
            "fax_number": "425-776-5511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "617 DAYTON ST STE 2",
            "address_2": "#A",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980203446",
            "telephone_number": "425-776-3399",
            "fax_number": "425-776-5511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHENY",
        "first_name": "THEODORE",
        "middle_name": "RAYMOND",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2010-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00040536",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8289753",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephanie Susana Martinez
• Marvin R Nelson DDS
• Jessica Michelle Mason, PSY.D.
• Vicki Ann Mason, OT/L
• Michelle Elaine Massey, LICSW
• Olivia Danielle Mathisen-Holloman, R.D.N.
• Andrea Matrone
• Brandon T Matsumiya, PHD
• Monica Matthews, LMHCA, MHP, SUDPT
• Kailey Anne Matulich

• Family Medicine Physician in Edmonds, WA
• Providers in Edmonds, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2010; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.