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SHANE VERL THEOBALD CRNA
NPI 1174783492
Nurse Anesthetist, Certified Registered in Vernal, UT

Active since June 10, 2008Accepts Medicare Assignment
151 W 200 N, VERNAL, UT 84078(435) 781-1519(435) 781-1519 Get Directions Write a Review

NPPES record last updated: June 10, 2008. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Shane Verl Theobald Crna NPPES

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

SHANE VERL THEOBALD CRNA (NPI 1174783492) is an individual nurse anesthetist, certified registered in Vernal, Utah, licensed in Utah (4938276-4406) and active in the NPI registry since June 2008. He is a graduate of Other (2007).

NPPES Registry Identity

NPI1174783492
Entity TypeIndividualMale
Primary Taxonomy367500000X
Provider Legal NameSHANE VERL THEOBALDCredential: CRNA
Location Address151 W 200 NVernal, UT 84078-1907
Mailing AddressPo Box 790164Vernal, UT 84079-0164 · (435) 781-1519 · Fax (435) 781-1519
Phone(435) 781-1519
Fax(435) 781-1519
Sole ProprietorNo
Medical School CMSOtherGraduated 2007
Enumeration DateJune 10, 2008
✔ NPI 1174783492 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code367500000X
License✔ Licensed in UT · 4938276-4406
Definition
(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition.
151 W 200 N, Vernal, UT 84078
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Shane Verl Theobald Crna 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 ID9234289737
PECOS Enrollment IDI20090603000570

Medicare Billing Reassignments

3

Medicare enrollment records show Shane Theobald reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Riverwoods Anesthesia PLLC
117 mi
Anesthesiology
320 RIVER PARK DR STE 195
Provo, UT 84604
  • Reassigned Medicare billing, Utah enrollment
  • 16 clinicians in this Medicare group
NPI 1821290883 (801) 437-4500
Mountain View Anesthesia Lc
119 mi
Anesthesiology
750 W 800 N, TIMPANOGOS REGIONAL HOSPITAL
Orem, UT 84057
  • Reassigned Medicare billing, Utah enrollment
  • 73 clinicians in this Medicare group
NPI 1043249840 (801) 714-6000
Sevier Valley Anesthesia Group, LLP
188 mi
Nurse Anesthetist, Certified Registered
1000 N MAIN ST
Richfield, UT 84701
  • Reassigned Medicare billing, Utah enrollment
  • 17 clinicians in this Medicare group
NPI 1487895462 (435) 893-4100

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims

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.

Anesthesia for exam of colon using an endoscope 00812
Anesthesia for a colon examination with an endoscope is a method used to ensure comfort during the procedure. It involves administering medication to help you relax or sleep, thus reducing discomfort as the endoscope, a thin, flexible tube, is navigated through your colon.
11 services11 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 84078 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
$125.70 typical visit price
range $54.34 – $166.03
Typical copayment $31.42 (range $13.58 – $41.50)
Most-billed visit code 99204
Established Patient
$68.01 typical visit price
range $17.23 – $135.20
Typical copayment $17.00 (range $4.30 – $33.80)
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.

Other Providers at the Same Location NPPES 13

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

JOYCE F BUHLER RD CD CDE
Dietitian, Registered
151 W 200 N
VERNAL, UT 84078
Uintah County (435) 789-3342
DEAN G ANDERSON M.D.
Emergency Medicine
151 W 200 N, ASHLEY REGIONAL MEDICAL CENTER
VERNAL, UT 84078
Uintah County (435) 789-3342
HILARY J. SARHATT DO
Family Medicine
151 W 200 N
VERNAL, UT 84078
Uintah County (435) 789-3342
BASIN ANESTHESIA ASSOCIATES, INC.
Nurse Anesthetist, Certified Registered
151 W 200 N
VERNAL, UT 84078
Uintah County (435) 789-3342
MR. MICHAEL ARTHUR HARTMAN
Nurse Anesthetist, Certified Registered
151 W 200 N
VERNAL, UT 84078
Uintah County (435) 789-3352
BRUCE A DANIEL MD
Emergency Medicine
151 W 200 N
VERNAL, UT 84078
Uintah County (435) 789-3342
GAVEN MCKAY SPEARS
Speech-Language Pathologist
151 W 200 N
VERNAL, UT 84078
Uintah County (970) 488-9300
DAVID ANDREW BESTENELHNER PHARM. D.
Pharmacist
151 W 200 N
VERNAL, UT 84078
Uintah County (435) 789-3342

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 Shane Theobald's NPI number?

The NPI number for Shane Theobald is 1174783492. It was assigned to this individual provider in the NPPES registry on June 10, 2008.

Where is Shane Theobald located?

Shane Theobald practices at 151 W 200 N, Vernal, UT 84078. The listed phone number is (435) 781-1519.

What is Shane Theobald's specialty?

The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.

Is Shane Theobald enrolled in Medicare?

Yes. Shane Theobald 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.

Which organizations bill Medicare for Shane Theobald's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Shane Theobald reassigns Medicare benefits to 3 organizations: Riverwoods Anesthesia PLLC (Provo, UT), Mountain View Anesthesia Lc (Orem, UT) and Sevier Valley Anesthesia Group, LLP (Richfield, UT). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Shane Theobald's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Shane Theobald was last updated on June 10, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.