Shoba Theivanayagam, M.D

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

ME148442 Issued in FL

Practice address

812 W Oak St
Kissimmee, FL 34741-6625

Phone

(407) 201-3686

Fax

(407) 201-3739

NPI assigned

Jul 17, 2007

Last updated

Oct 27, 2021By 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

Enrolled in FL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Gastroenterology

Education

Other, 2003

Medicare assignment

May accept Medicare assignment

Group practices

Gastroenterology Institute of Orlando LLCGroup PAC ID 1355619586, 6 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventhealth Orlando Hospital, Orlando, FL, CCN 100007

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

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.

• Gastroenterology Institute of Orlando LLC

  • Gastroenterology Physician
  • Orlando, FL
  • NPI 1225493729
  Medicare reassignment Care Compare group NPD
• Cardiovascular Institute of Orlando, PLLC

  • Cardiovascular Disease Physician
  • Orlando, FL
  • NPI 1215267497
  NPD

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

• Adventist Health System-Sunbelt, Inc

  dba AdventHealth Orlando

  • General Acute Care Hospital
  • Orlando, FL
  • NPI 1306938071
  Care Compare affiliation
• Adventist Health System-Sunbelt, Inc

  dba AdventHealth Orlando Outreach Laboratory

  • Clinical Medical Laboratory
  • Orlando, FL
  • NPI 1801569728

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1184630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635292800000",
    "number": "1730388067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 782009",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328782009",
            "telephone_number": "407-201-3686",
            "fax_number": "407-201-3739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 W OAK ST",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347416625",
            "telephone_number": "407-201-3686",
            "fax_number": "407-201-3739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEIVANAYAGAM",
        "first_name": "SHOBA",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-17",
        "last_updated": "2021-10-27",
        "certification_date": "2021-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "FL",
            "license": "ME148442",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Vascular Clinic & Cosmetic Vein Treatment Center PL (Scott R Hannum DO PL)
• The Velz Group Foundation Inc
• The Velz Group Foundation Inc
• Tiffany M Theard, MS, FNP-C, RN, CRRN
• Douglas S Thein, RPH
• Fabiola Thelemaque
• Gracica Thelusma, RBT
• Beverley J Thelwell
• Valerie Theodore
• Elli Theodorou, RN,BSN

• Gastroenterology Physician in Kissimmee, FL
• Providers in Kissimmee, FL by specialty
• Gastroenterology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 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.