Shane Verl Theobald, CRNA - Medicare Nurse Anesthetist, Certified Registered in Vernal, UT

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Shane Verl Theobald, CRNA is a medicare enrolled "Nurse Anesthetist, Certified Registered" in Vernal, Utah. His current practice location is 151 W 200 N, Vernal, Utah. You can reach out to his office (for appointments etc.) via phone at (435) 781-1519.

Shane Verl Theobald is licensed to practice in Utah (license number 4938276-4406) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1174783492.

Contact Information

Shane Verl Theobald, CRNA
151 W 200 N,
Vernal, UT 84078-1907
(435) 781-1519
(435) 781-1519

Map and Direction




Provider's Profile

Full NameShane Verl Theobald
GenderMale
SpecialityNurse Anesthetist, Certified Registered
Location151 W 200 N, Vernal, Utah
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1174783492
  • Provider Enumeration Date: 06/10/2008
  • Last Update Date: 06/10/2008
  Medicare PECOS Information:
  • PECOS PAC ID: 9234289737
  • Enrollment ID: I20090603000570

Medical Identifiers

Medical identifiers for Shane Verl Theobald such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1174783492NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
367500000XNurse Anesthetist, Certified Registered 4938276-4406 (Utah)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. Shane Verl Theobald allows following entities to bill medicare on his behalf.
Entity NameMountain View Anesthesia Lc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1043249840
PECOS PAC ID: 5991604829
Enrollment ID: O20040108000626
Entity NameRiverwoods Anesthesia Pllc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1821290883
PECOS PAC ID: 0547217366
Enrollment ID: O20050405000096
Entity NameSevier Valley Anesthesia Group Llp
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1487895462
PECOS PAC ID: 5991855389
Enrollment ID: O20090605000031

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. Shane Verl 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 AddressPractice Location Address
Shane Verl Theobald, CRNA
Po Box 790164,
Vernal, UT 84079-0164

Ph: (435) 781-1519		Shane Verl Theobald, CRNA
151 W 200 N,
Vernal, UT 84078-1907

Ph: (435) 781-1519

Reviews and Comments


Nurse Anesthetist, Certified Registered Nurses in Vernal, UT

Pauline Frome, CRNA
Nurse Anesthetist - CR
Medicare: Not Enrolled in Medicare
Practice Location: 3021 E 5000 S, Vernal, UT 84078
Phone: 435-790-1877    
Mr. Michael Arthur Hartman,
Nurse Anesthetist - CR
Medicare: Accepting Medicare Assignments
Practice Location: 151 W 200 N, Vernal, UT 84078
Phone: 435-789-3352    Fax: 435-781-6893
Mr. Dee Lewis Bambrough, CRNA
Nurse Anesthetist - CR
Medicare: Not Enrolled in Medicare
Practice Location: 151 W 200 N, Vernal, UT 84078
Phone: 435-789-3342    Fax: 435-781-6893
Edwin Bulloch, CRNA
Nurse Anesthetist - CR
Medicare: Accepting Medicare Assignments
Practice Location: 150 W 100 N, Vernal, UT 84078
Phone: 207-659-8810    
Dustin Todd Bradley,
Nurse Anesthetist - CR
Medicare: Accepting Medicare Assignments
Practice Location: 808 W 300 N, Vernal, UT 84078
Phone: 435-828-2541    

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.