Jose M Theckedath, MD

Primary specialty

Allergy & Immunology PhysicianTaxonomy code 207K00000X

License

GA45992 Issued in GA

Practice address

1911 Palmyra Rd
Albany, GA 31701-1574

Phone

(229) 446-7227

Fax

(229) 420-4365

NPI assigned

Oct 3, 2006

Last updated

Mar 20, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

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

Dermatology

Education

Other, 1974

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Allergy & Immunology Center PC

  • Allergy & Immunology Physician
  • Albany, GA
  • NPI 1770863276
  Medicare reassignment Authorized official
• Hospital Authority of the City of Bainbridge and Decatur County

  dba Memorial Hospital and Manor

  • Multi-Specialty Clinic/Center
  • Bainbridge, GA
  • NPI 1053388256
  NPD (past)

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363737600000",
    "number": "1982798047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1911 PALMYRA RD",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317011574",
            "telephone_number": "229-446-7227",
            "fax_number": "229-420-4365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1911 PALMYRA RD",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317011574",
            "telephone_number": "229-446-7227",
            "fax_number": "229-420-4365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THECKEDATH",
        "first_name": "JOSE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2013-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "GA",
            "license": "GA45992",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000840386A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• The Madison
• The McCray Center, LLC
• The Natural Way
• The Renaissance Centre, Inc.
• The Veranda, PC
• Therapeutic Collaborative, LLC
• Therapy Express
• Thomas D Bailey MD PC
• Alma Thomas
• Amanda Banks Thomas, CNM

• Allergy & Immunology Physician in Albany, GA
• Providers in Albany, GA by specialty
• Allergy & Immunology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2013; 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.