Shane Theobald, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

1521 Issued in AZ

Practice address

1717 W. Chandler Blvd
Chandler, AZ 85224

Phone

(480) 821-7565

Fax

(480) 821-4303

NPI assigned

Jul 9, 2006

Sex

Male

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 AZ

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Southern College of Optometry, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Barnet Dulaney Perkins Eye Center, PCGroup PAC ID 0749288298, 104 clinicians

Southwestern Eye Center LTDGroup PAC ID 1850296989, 116 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

83.86 of 100Reported as group

Quality

81.82

Promoting interoperability

100

Improvement activities

40

Cost

64.4

Merit-based Incentive Payment System (MIPS)

Final score

88.66 of 100Reported as group

Quality

84.9

Promoting interoperability

100

Improvement activities

40

Cost

77.31

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations (25 of 29)

Interoperability endpoints

• Direct secure messaging: shane.theobald.p11@direct.avp.nextgenshare.com
• Direct secure messaging: shane.theobald.p20@direct.avp.nextgenshare.com

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.

• Barnet Dulaney Perkins Eye Center, PC

  dba American Vision Partners

  • Ophthalmology Physician
  • Phoenix, AZ
  • NPI 1376574707
  Medicare reassignment Care Compare group NPD
• Southwestern Eye Center LTD

  • Ophthalmology Physician
  • Scottsdale, AZ
  • NPI 1023063187
  Medicare reassignment Care Compare group NPD
• Barnet Dulaney Perkins Eye Center, PC

  dba American Vision Partners

  • Ambulatory Surgical Clinic/Center
  • Mesa, AZ
  • NPI 1043910078
  NPD
• Barnet Dulaney Perkins Eye Center, PC

  dba American Vision Partners

  • Ophthalmology Physician
  • Safford, AZ
  • NPI 1649202771
  NPD
• Cigna Health Care of Arizona Inc.

  dba CMG Clyde Wright Urgent Care, CMG Clyde Wright AHC, Phoenix Central UC

  • Urgent Care Clinic/Center
  • Phoenix, AZ
  • NPI 1245338235
  NPD
• Cigna Health Care of Arizona Inc.

  dba EVERNORTH Care Group Paradise Valley Multi-Specialty Center

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1619048048
  NPD
• Cigna Health Care of Arizona Inc.

  dba EVERNORTH Care Group CJ Harris Multi-Specialty Center

  • Multi-Specialty Clinic/Center
  • Tempe, AZ
  • NPI 1649341298
  NPD
• Cigna Health Care of Arizona Inc.

  dba Clyde Wright Center, CMG Phx Central MultiSpec Cntr

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1942371679
  NPD
• Cigna Healthcare of Arizona, Inc.

  dba EVERNORTH Care Group

  • Multi-Specialty Clinic/Center
  • Scottsdale, AZ
  • NPI 1073626404
  NPD
• Southwestern Eye Center LTD

  dba Southwestern Eye Center

  • Optometrist
  • Sedona, AZ
  • NPI 1144645391
  NPD
• Southwestern Eye Center, LTD

  • Durable Medical Equipment & Medical Supplies
  • Tempe, AZ
  • NPI 1558102608

  Optometrist

  NPD
• Barnet Dulaney Perkins Eye Center, PC

  dba American Vision Partners

  • Ophthalmology Physician
  • Cottonwood, AZ
  • NPI 1013952522
  NPD (past)

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393891200000",
    "number": "1760415947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25500 N. NORTERRA PARKWAY, BLDG B",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85085",
            "telephone_number": "623-277-1000",
            "fax_number": "602-906-2789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 W. CHANDLER BLVD",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "85224",
            "telephone_number": "480-821-7565",
            "fax_number": "480-821-4303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEOBALD",
        "first_name": "SHANE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-09",
        "last_updated": "2014-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "1521",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Route
• The Southwest Center for Obsessive Compulsive Disorders LLC
• The Talk Teachers, LLC
• The Wellness Connection LLC
• The Wellness Medical Clinic PC
• Therapoints LLC (Chandler Acupuncture)
• Therapro Physical Therapy Services, LLC
• Therapy and Language for Kids, LLC
• Therapy Matters, Inc.
• Therapy Network, Inc

• Optometrist in Chandler, AZ
• Providers in Chandler, AZ by specialty
• Optometrist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2014; 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.