Elizabeth Anne Theis, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1236671 Issued in PA

Practice address

5501 Old York Rd
Philadelphia, PA 19141-3018

Phone

(412) 600-6900

NPI assigned

Oct 29, 2025

Last updated

Oct 29, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Einstein Practice Plan Inc

  dba Northern Vascular Lab

  • Surgery Physician
  • Philadelphia, PA
  • NPI 1992761621
  NPD (past)

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

{
    "created_epoch": "1761696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761696000000",
    "number": "1700755733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 LOGAN RD",
            "city": "TARENTUM",
            "state": "PA",
            "postal_code": "150842624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5501 OLD YORK RD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191413018",
            "telephone_number": "412-600-6900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEIS",
        "first_name": "ELIZABETH",
        "middle_name": "ANNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-10-29",
        "last_updated": "2025-10-29",
        "certification_date": "2025-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "1236671",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Wedge Medical Center, P.C. (Wedge Recovery Centers)
• The Wedge Medical Center, P.C.
• The Wedge Medical Center, P.C.
• Linda Thea
• Simon Daniel Xavier Thebault, M.D.
• Sandhra Thekkumthala, CRNP
• Ryna Then, M.D.
• Theodore B Porter, DO, PC
• Nicole Michelle Theodore, REGISTERED NURSE
• Ioannis Theodoropoulos, M.D.

• Physician Assistant in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.