MR. GEOFFREY J THEOBALD (NPI# 1780642082) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780642082 |
| Entity Type | Individual |
| Full Name | MR. GEOFFREY J THEOBALD |
| Credential | P.A.-C |
| Practice Address |
1000 W 140th St Suite 201 Burnsville MN 55337-4480 |
| Mailing Address |
4200 Dahlberg Dr Suite 300 Golden Valley MN 55422-4840 |
| Practice Telephone | 9528986300 |
| Practice Fax Number | 9528986035 |
| Mailing Telephone | 9525125600 |
| Mailing Fax Number | 9525125651 |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2012-08-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 10003 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1000 W 140TH ST SUITE 201 |
| City | BURNSVILLE |
| State | MN |
| Zip Code | 55337-4480 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689151185 | Jay Vincent Ellerbusch | Physical Therapist | 1000 W 140th St, Burnsville, MN 55337-4480 | 2018-07-26 |
| 1902359219 | Megan M Dean | Physical Therapist | 1000 W 140th St, Suite 201, Burnsville, MN 55337-4480 | 2016-08-03 |
| 1508233230 | Jennifer Lauren Smidl | Physical Therapist | 1000 W 140th St, Suite 201, Burnsville, MN 55337-4480 | 2015-08-28 |
| 1609260579 | Jason Arthur Johnson | Physician Assistant | 1000 W 140th St, Suite 201, Burnsville, MN 55337-4480 | 2015-03-27 |
| 1376931527 | Michael Allen Steiner | Physical Therapist | 1000 W 140th St, Suite 201, Burnsville, MN 55337-4480 | 2014-12-22 |
| 1417376856 | Alyssa Meredith Hardy | Occupational Therapist | 1000 W 140th St, Suite 201, Burnsville, MN 55337-4480 | 2014-04-14 |
| 1326462607 | Lindsey Jaine Anderson | Physician Assistant | 1000 W 140th St, Suite 201, Burnsville, MN 55337-4480 | 2014-02-07 |
| 1093142473 | Joshua John Bennington | Physician Assistant | 1000 W 140th St, Suite 201, Burnsville, MN 55337-4480 | 2013-10-01 |
| 1841626827 | Ashley Marie Meyer | Physician Assistant | 1000 W 140th St, Suite 201, Burnsville, MN 55337-4480 | 2013-09-23 |
| 1386086502 | Roberta Amber Bolitho | Specialist/Technologist, Other | 1000 W 140th St, Suite 201, Burnsville, MN 55337-4480 | 2013-07-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053939397 | Alpha Quality Care1 L. L. C. | Home Infusion | 12924 18th Ave South, Burnsville, MN 55337 | 2020-07-13 |
| 1568085900 | Kathryn Harris | Counselor | 11939 W. River Hills Dr., Burnsville, MN 55337 | 2020-05-20 |
| 1952941254 | Noah Home Care Inc. | Home Health | 13521 Nicollet Lane, Burnsville, MN 55337 | 2020-01-14 |
| 1750854287 | Baraka Home Care LLC | Nursing Care | 1700 James Place, Burnsville, MN 55337 | 2019-01-08 |
| 1699298778 | Raphael Cheron-dittmann | Hearing Instrument Specialist | 14000 Nicollet Ave. S., Suite 303, Burnsville, MN 55337 | 2017-07-20 |
| 1669909818 | Mercy Home Care Ltd | Hospice Care, Community Based | 1020 E 146th St Ste 220d, Burnsville, MN 55337 | 2017-05-18 |
| 1457893984 | Daniel Ryan Nguyen | Physician Assistant | 14551 Co Rd #11 #100, Burnsville, MN 55337 | 2016-11-15 |
| 1730542572 | Iris Reproductive Psychiatric Clinic | Clinical Nurse Specialist | 1500 Mcandrews Road W, Ste 227, Burnsville, MN 55337 | 2016-03-30 |
| 1740657204 | Mercy Link, LLC | Home Health | 13005 Salem Pl, Burnsville, MN 55337 | 2015-08-31 |
| 1669852158 | Mixa Dipak Patel | Physical Therapy Assistant | 8380 Hiawatha Ave, Eden Prairie, MN 55337 | 2015-06-01 |
| Find all providers in zip 55337 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972137081 | Ryan M Helf | Physician Assistant | 1000 W 140th St Ste 100, Burnsville, MN 55337-4835 | 2020-02-27 |
| 1508324328 | Alexa Jordan Stilp | Physician Assistant | 350 W Burnsville Pkwy Ste 200, Burnsville, MN 55337-2598 | 2019-03-11 |
| 1487043279 | Briana Rae Donald | Physician Assistant | 14000 Nicollet Ave So., Burnsville, MN 55337 | 2015-01-15 |
| 1629499249 | Emily Lynn Parenteau | Physician Assistant | 810 County Road 42w, Burnsville, MN 55337 | 2013-12-27 |
| 1396173746 | Matthew Michael Johnson | Physician Assistant | 14000 Nicollet Ave Fl 1, Burnsville, MN 55337-5790 | 2013-10-23 |
| 1568437879 | Kelly L Dziedzic | Physician Assistant | 1000 W 140th St Unit 201, Burnsville, MN 55337-4833 | 2006-02-21 |
| 1639163249 | Jennifer Lynn Smith | Physician Assistant | 810 County Road 42 W, Burnsville, MN 55337-4426 | 2005-09-09 |
| 1518509652 | Melissa Charron | Physician Assistant | 501 E Nicollet Blvd Ste 100, Burnsville, MN 55337-6772 | 2019-10-10 |
| 1821657065 | Kaitlyn Mae Gretsch | Physician Assistant | 201 E Nicollet Blvd, Burnsville, MN 55337-5714 | 2019-06-11 |
| 1326532235 | Nathan Joseph Marcus | Physician Assistant | 1000 W 140th St Unit 201, Burnsville, MN 55337 | 2018-06-15 |
| Find all providers in BURNSVILLE | ||||
| City | BURNSVILLE |
| Zip Code | 55337 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.