Shana Theobald, MD is a medicare enrolled "Family Medicine" physician in Hana, Hawaii. Her current practice location is
4590 Hana Hwy, Hana, Hawaii. You can reach out to her office (for appointments etc.) via phone at
(808) 856-1141.
Shana Theobald is licensed to practice in Hawaii (license number 19456) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1629399316.
Physician's Profile
Full Name | Shana Theobald |
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Gender | Female |
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Speciality | Family Medicine |
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Location | 4590 Hana Hwy, Hana, Hawaii |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1629399316
- Provider Enumeration Date: 06/16/2010
- Last Update Date: 03/27/2019
Medicare PECOS Information:
- PECOS PAC ID: 6103067566
- Enrollment ID: I20191023002906
Medical Identifiers
Medical identifiers for Shana Theobald such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1629399316 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
207Q00000X | Family Medicine | 7901 (Alaska) | Secondary |
207Q00000X | Family Medicine | 19456 (Hawaii) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Shana Theobald allows following entities to bill medicare on her behalf.
Entity Name | Maniilaq Association |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1861698805 PECOS PAC ID: 6103881792 Enrollment ID: O20041123000372 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Shana Theobald is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Shana Theobald, MD Po Box 807, Hana, HI 96713-0807 Ph: (808) 856-1141 | Shana Theobald, MD 4590 Hana Hwy, Hana, HI 96713 Ph: (808) 856-1141 |
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