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DR. THEODORE J COLE DO
NPI 1063694966
Family Medicine in West Chester, OH

Active since December 03, 2007PECOS EnrolledAccepts Medicare Assignment
7760 UNIVERSITY CT, SUITE C, WEST CHESTER, OH 45069(513) 563-4321(513) 847-1017 Get Directions Write a Review

NPPES record last updated: January 3, 2012. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Dr. Theodore J Cole Do NPPES

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

DR. THEODORE J COLE DO (NPI 1063694966) is an individual family medicine provider in West Chester, Ohio, licensed in Ohio (34004375C) and active in the NPI registry since December 2007. He is enrolled in Medicare PECOS, is affiliated with West Chester Hospital, and is a graduate of Ohio University, College Of Osteopathic Medicine (1986).

NPPES Registry Identity

NPI1063694966
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameDR. THEODORE J COLECredential: DO
Location Address7760 UNIVERSITY CT, SUITE CWest Chester, OH 45069-3371
Mailing Address7760 University Ct, Suite CWest Chester, OH 45069-3371 · (513) 563-4321 · Fax (513) 847-1017
Phone(513) 563-4321
Fax(513) 847-1017
Sole ProprietorNo
Medical School CMSOhio University, College Of Osteopathic MedicineGraduated 1986
Enumeration DateDecember 3, 2007
Last NPPES UpdateJanuary 3, 2012
✔ NPI 1063694966 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in OH · 34004375C
Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

7760 UNIVERSITY CT, West Chester, OH 45069
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Other Identifiers 7

Other0437505OH · Humana Choice Care
Other080150714OH · Rr Mcare
Medicare UPINA17598OH
Other000000017595OH · Anthem
Other0104689OH · United Healthcare
Other1537037OH · Umwa Health And Retiremen
Medicare PIN9274621OH

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Theodore J Cole Do is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3678734092
PECOS Enrollment IDI20120411000857
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.

Areas of Expertise CMS Part B claims 4

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215
This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.
473 services111 patients
New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more 99205
This is a first-time patient visit where a healthcare professional spends 60-74 minutes with you. It involves a comprehensive evaluation, including your medical history and current health condition. They'll also advise on preventive health measures and formulate a treatment plan if needed.
32 services32 patients
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204
This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
25 services25 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
18 services12 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

West Chester Hospital

Acute Care Hospitals · West Chester, OH
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number360354
Location7700 University DriveWest Chester, OH 45069 · Butler County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 45069 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$84.72 typical visit price
range $54.34 – $166.65
Typical copayment $21.18 (range $13.58 – $41.66)
Most-billed visit code 99203
Established Patient
$96.44 typical visit price
range $17.10 – $135.40
Typical copayment $24.11 (range $4.27 – $33.85)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

Reported Quality Measures

Diabetes: Medical Attention for Nephropathy
The percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period
25%32 patients1/55-star benchmark: 99%
Documentation of Current Medications in the Medical Record
Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter.
27%2,176 patients1/55-star benchmark: 100%
e-Prescribing
At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.
95%966 patients4/55-star benchmark: 100%
Medication Reconciliation
The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.
69%439 patients2/55-star benchmark: 100%
Patient-Specific Education
The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.
64%989 patients3/55-star benchmark: 99%
Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous…
37%735 patients2/55-star benchmark: 97%
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user
Patients tobacco: 54% · 315 patients
64%405 patients
Provide Patient Access
At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold…
94%989 patients4/55-star benchmark: 100%
Secure Messaging
For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure…
2%989 patients1/55-star benchmark: 59%
Use of High-Risk Medications in the Elderly
Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are submitted. 1) Percentage of patients who were ordered at least one high-risk medication.
Lower rates are better for this measure.
Patients 2+: 20% · 170 patients
27%170 patients1/55-star benchmark: 100%
Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

COMPASSIONATE CANCER CARE & RESEARCH
Specialist
7760 UNIVERSITY CT, STE H
WEST CHESTER, OH 45069
Butler County (513) 423-0504
JAYASREE JAYADEVAN NANDAGOPAL MD
Psychiatry & Neurology (Psychiatry)
7760 UNIVERSITY CT, SUITE H
WEST CHESTER, OH 45069
Butler County (513) 547-4491
COLE CENTER FOR HEALING, INC
Family Medicine
7760 UNIVERSITY CT, STE C
WEST CHESTER, OH 45069
Butler County (513) 563-4321
SERENITY BEHAVIORAL SCIENCE CENTER
Psychiatry & Neurology (Psychiatry)
7760 UNIVERSITY CT, SUITE H
WEST CHESTER, OH 45069
Butler County (513) 847-4491

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Theodore Cole's NPI number?

The NPI number for Theodore Cole is 1063694966. It was assigned to this individual provider in the NPPES registry on December 3, 2007.

Where is Theodore Cole located?

Theodore Cole practices at 7760 University Ct Suite C, West Chester, OH 45069. The listed phone number is (513) 563-4321.

What is Theodore Cole's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Theodore Cole enrolled in Medicare?

Yes. Theodore Cole is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Theodore Cole accept?

Health plans from UnitedHealthcare list Theodore Cole as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Theodore Cole affiliated with any hospitals?

According to CMS data, Theodore Cole is affiliated with West Chester Hospital.

When was this NPI record last updated?

The NPPES record for Theodore Cole was last updated on January 3, 2012. NPI Profile syncs with the weekly NPPES data releases published by CMS.