Michael R Theobald, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

ME73419 Issued in FL

Practice address

14551 Hope Center Loop Ste 100
Fort Myers, FL 33912-4705

Phone

(239) 936-2316

Fax

(239) 834-6106

NPI assigned

Aug 19, 2005

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

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Diagnostic Radiology

Education

Georgetown University School of Medicine, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Radiology Regional Center P aGroup PAC ID 9638151756, 60 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

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 and National Provider Directory roles.

• Radiology Regional Center P a

  • Diagnostic Radiology Physician
  • Fort Myers, FL
  • NPI 1407809262
  Medicare reassignment Care Compare group NPD
• Radiology Regional Center Professional Services LLC

  • Diagnostic Radiology Physician
  • Fort Myers, FL
  • NPI 1619365772
  Medicare reassignment NPD
• Anchor Health Centers PA

  • Family Medicine Physician
  • Naples, FL
  • NPI 1174571608

  Diagnostic Radiology

  NPD (past)
• Morgan Medical Corp

  • Diagnostic Radiology Physician
  • Titusville, FL
  • NPI 1679566756
  NPD (past)
• Naples Diagnostic Imaging Center LTD

  • Diagnostic Radiology Physician
  • Naples, FL
  • NPI 1609868447
  NPD (past)
• Radiology Regional Center, PA

  • Diagnostic Radiology Physician
  • Port Charlotte, FL
  • NPI 1013683838
  NPD (past)
• Radiology Regional Center, PA

  • Diagnostic Radiology Physician
  • Cape Coral, FL
  • NPI 1992471791
  NPD (past)

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

{
    "created_epoch": "1124409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707782400000",
    "number": "1952393464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3660 BROADWAY",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339018005",
            "telephone_number": "239-425-4745",
            "fax_number": "239-834-6106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14551 HOPE CENTER LOOP STE 100",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339124705",
            "telephone_number": "239-936-2316",
            "fax_number": "239-834-6106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEOBALD",
        "first_name": "MICHAEL",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-19",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "ME73419",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "252181400",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "300085121",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "300085120",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• The Springs Health Care
• The Sterling Center Organization Inc.
• Aleisha Nicole Thearle, PA-C
• Franzdy Thelemaque
• Afton D Theobald
• Arielle Theodore, LMHC
• Evan T. Theoharis, M.D.
• Therapeutic Massage of Southwest Florida, Inc.
• Therapeutic Skin Care and Massage Center
• Therapy First LLC

• Diagnostic Radiology Physician in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Diagnostic Radiology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2024; 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.