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THEODORE THIEN PHAN
NPI 1104546969
Physician Assistant in Novato, CA

Active since August 31, 2022PECOS Enrolled
94.62/100
CMS Quality Rating
52 TRINITY DR, NOVATO, CA 94947(415) 320-2313 Get Directions Write a Review

NPPES record last updated: December 5, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Dec 5, 2022, Aug 31, 2022 (2 updates tracked since 2022).

About Theodore Thien Phan NPPES

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

THEODORE THIEN PHAN (NPI 1104546969) is an individual physician assistant in Novato, California, licensed in California (61808) and active in the NPI registry since August 2022. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1104546969
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameTHEODORE THIEN PHAN
Location Address52 TRINITY DRNovato, CA 94947-5246
Mailing Address52 Trinity DrNovato, CA 94947-5246 · (415) 320-2313
Phone(415) 320-2313
Sole ProprietorYes
Enumeration DateAugust 31, 2022
Last NPPES UpdateDecember 5, 20222 updates tracked since enumeration
NPPES CertifiedDecember 5, 2022
✔ NPI 1104546969 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in CA · 61808
Definition
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.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
52 TRINITY DR, Novato, CA 94947
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Theodore Thien Phan 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 94947 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
$104.67 typical visit price
range $69.07 – $202.63
Typical copayment $26.16 (range $17.26 – $50.65)
Most-billed visit code 99203
Established Patient
$85.00 typical visit price
range $23.44 – $166.64
Typical copayment $21.25 (range $5.86 – $41.66)
Most-billed visit code 99213
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.

94.62/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality76.67
Improvement Activities40
Cost97.14

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 Phan's NPI number?

The NPI number for Theodore Phan is 1104546969. It was assigned to this individual provider in the NPPES registry on August 31, 2022.

Where is Theodore Phan located?

Theodore Phan practices at 52 Trinity Dr, Novato, CA 94947. The listed phone number is (415) 320-2313.

What is Theodore Phan's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Theodore Phan enrolled in Medicare?

Yes. Theodore Phan is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Theodore Phan was last updated on December 5, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.