DALE E. THEOBALD M.D., PH.D.
NPI 1053383083
Psychiatry & Neurology - Addiction Psychiatry in Indianapolis, IN

Q: What is Dale Theobald's NPI number?

The NPI number for Dale Theobald is 1053383083. It was assigned to this individual provider in the NPPES registry on February 3, 2006.

Q: What is Dale Theobald's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Addiction Psychiatry, with taxonomy code 2084P0802X.

Q: When was this NPI record last updated?

The NPPES record for Dale Theobald was last updated on November 27, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since February 03, 2006PECOS Enrolled

7229 CLEARVISTA DR, INDIANAPOLIS, IN 46256(317) 621-4341(317) 621-4366 Get Directions Write a Review

NPPES record last updated: November 27, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Sep 8, 2020, Apr 17, 2017 (2 updates tracked since 2017).

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About Dale E. Theobald M.d., Ph.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DALE E. THEOBALD M.D., PH.D. (NPI 1053383083) is an individual addiction psychiatry provider in Indianapolis, Indiana, licensed in Indiana (200110234A) and active in the NPI registry since February 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1053383083

Entity TypeIndividualMale

Primary Taxonomy2084P0802X

Provider Legal NameDALE E. THEOBALDCredential: M.D., PH.D.

Location Address7229 CLEARVISTA DRIndianapolis, IN 46256-1698

Mailing Address6626 E 75th St, Suite 500Indianapolis, IN 46250-2805

Phone(317) 621-4341

Fax(317) 621-4366

Sole ProprietorNo

Enumeration DateFebruary 3, 2006

Last NPPES UpdateNovember 27, 20232 updates tracked since enumeration

NPPES CertifiedSeptember 8, 2020

✔ NPI 1053383083 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychiatry & Neurology · Addiction PsychiatryAllopathic & Osteopathic Physicians

Taxonomy Code2084P0802X

License✔ Licensed in IN · 200110234A

Definition

Addiction Psychiatry is a subspecialty of psychiatry that focuses on evaluation and treatment of individuals with alcohol, drug, or other substance-related disorders, and of individuals with dual diagnosis of substance-related and other psychiatric disorders.

7229 CLEARVISTA DR, Indianapolis, IN 46256

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Other Identifiers 2

Other000000538641IN · Anthem

Medicaid100134220IN

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dale E. Theobald M.d., Ph.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

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