Individual provider Active NPI

Mary Theoktisto

  • Infectious Disease Physician
  • Lakeway, TX
National Provider Identifier
1619358934
Registry record updated Aug 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
S3323 Issued in TX
Practice address
100 Medical Pkwy
Lakeway, TX 78738-5621
Phone
(512) 571-5000
NPI assigned
Jun 11, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease Physician 207RI0200X S3323 TX Primary

Addresses

Primary practice location

100 Medical Pkwy
Lakeway, TX 78738-5621

Mailing address

PO Box 844658
Dallas, TX 75284-4658
Phone (254) 724-8800

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mtheoktisto689899@direct.sw.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20191218000921 TX Practitioner - Internal MedicinePractitioner - Infectious Disease 9537593967 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Infectious Disease
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Scott and White ClinicGroup PAC ID 8123923604, 2,426 clinicians

Practice addresses (Care Compare)

100 Medical Pkwy
Lakeway, TX 78738-5621
Phone (512) 571-5000

1001 Westbank Dr
Baylor Scott and White Clinic Westlake
Baylor Scott & White Clin, TX 78746-6669
Phone (512) 654-4150

10815 Ranch Rd
2222 Suite 100
Austin, TX 78730-1159
Phone (512) 327-4262

1300 E Polk St
Baylor Scott and White Clinic Burnet
Burnet, TX 78611-2136
Phone (512) 715-6400

1605 S 31St St
Baylor Scott and White Center for Dia
Temple, TX 76508-0001
Phone (254) 215-0100

1701 E Pflugerville Pkwy
Baylor Scott and White Clinic Pflug
Pflugerville, TX 78660-8990
Phone (512) 259-6000

200 Medical Pkwy
Lakeway, TX 78738-1794

2401 S 31 St
Temple, TX 76508-0001
Phone (254) 724-2459

2401 S 31St St BLDG
35 Baylor Scott and White Roney Bone and
Temple, TX 76508-0001
Phone (254) 724-2663

2600 E Pflugerville Pkwy
Pflugerville, TX 78660-5999

305 Mallard LN
Taylor, TX 76574-1208
Phone (512) 352-7611

3108 Ranch Rd 620
Lakeway, TX 78738-5635
Phone (512) 654-4200

5245 W Hwy 290
Baylor Scott and White Medical Center Austi
Austin, TX 78735-8963
Phone (512) 654-2100

5251 W Hwy 290
Baylor Scott and White Clinic Austin Oak Hi
Austin, TX 78735-8963
Phone (512) 654-3000

5251 W Hwy 290 100
Baylor Scott and White Cancer and Infusion Ce
Austin, TX 78735-8963
Phone (512) 654-4319

5330 Overpass Rd
Buda, TX 78610-2300

7451 W State Hwy 29
Baylor Scott and White Clinic Georg
Georgetown, TX 78628-6849
Phone (512) 509-8700

800 W Hwy 71
Baylor Scott and White Specialty Clinic
Marble Falls, TX 78654-8602
Phone (830) 201-7100

810 W Hwy 71
Marble Falls, TX 78654-8602
Phone (830) 201-7100

810 W U Ave
Temple, TX 76508-0001
Phone (254) 724-2585

9521 W US Hwy 290 105
Baylor Scottandwhite Clinic Austi
Austin, TX 78736-7898
Phone (512) 654-4300

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
S3323TXMDInfectious Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Scott & White Clinic Internal Medicine CurrentSince May 20, 2020 Accepting new patients
Hospitalist Medicine Physicians of Texas, PLLC Internal Medicine CurrentSince Oct 1, 2019 Accepting new patients
Scott & White Clinic Internal Medicine Current Accepting new patients
Scott & White Clinic Internal Medicine CurrentSince May 20, 2020 Accepting new patients
Scott & White Hospital - Taylor Past Accepting new patients

Locations

5410 Maryland Way
Ste 300
Brentwood, TN 37027
Phone (615) 377-1674

5251 W Highway 290
Austin, TX 78735
Phone (512) 654-3000

601 E 15th St
Austin, TX 78701
Phone (512) 324-7868

101 Lafferty Ave
Cameron, TX 76520
Phone (254) 605-1100

18951 N Memorial Dr
Humble, TX 77338
Phone (281) 319-8409

200 Medical Pkwy
Ste 110
Lakeway, TX 78738
Phone (512) 571-5000

100 Medical Pkwy
Lakeway, TX 78738
Phone (512) 206-8100

810 W Highway 71
Marble Falls, TX 78654
Phone (830) 201-7100

1701 E Pflugerville Pkwy
Pflugerville, TX 78660
Phone (512) 259-6000

2827 Babcock Rd
San Antonio, TX 78229
Phone (210) 253-9955

2401 S 31st St
Temple, TX 76508
Phone (254) 724-2459

2600 Saint Michael Dr
Texarkana, TX 75503
Phone (903) 614-1000

Interoperability endpoints

  • Direct secure messaging: mtheoktisto689899@direct.sw.org

Organizations & group practices 5

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1433980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597881600000",
    "number": "1619358934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658",
            "telephone_number": "254-724-8800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MEDICAL PKWY",
            "city": "LAKEWAY",
            "state": "TX",
            "postal_code": "787385621",
            "telephone_number": "512-571-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEOKTISTO",
        "first_name": "MARY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-11",
        "last_updated": "2020-08-20",
        "certification_date": "2020-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "TX",
            "license": "S3323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mtheoktisto689899@direct.sw.org",
            "affiliation": "N",
            "address_1": "100 Medical Pkwy",
            "city": "Lakeway",
            "state": "TX",
            "country_code": "US",
            "postal_code": "787385621",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lakeway, TX

Sources for this page

Verify at the official NPI Registry.