1. Home
  2. Directory
  3. Alabama
  4. Madison
  5. Psychiatry Neurology
  6. NPI Profile

THEODROS MENGESHA MD
NPI 1184771909
Psychiatry & Neurology - Neurology in Madison, AL

Active since January 04, 2007PECOS EnrolledAccepts Medicare Assignment
84.33/100
CMS Quality Rating
8484 WANN DR NW STE A, MADISON, AL 35758(256) 963-9444(256) 963-9446 Get Directions Write a Review

NPPES record last updated: November 17, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Nov 17, 2024, Apr 17, 2024, Jan 17, 2020 (3 updates tracked since 2020).

About Theodros Mengesha Md NPPES

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

THEODROS MENGESHA MD (NPI 1184771909) is an individual neurology provider in Madison, Alabama, licensed in Alabama (28347) and active in the NPI registry since January 2007. He is enrolled in Medicare PECOS and is a graduate of Other (1985).

NPPES Registry Identity

NPI1184771909
Entity TypeIndividualMale
Primary Taxonomy2084N0400X
Provider Legal NameTHEODROS MENGESHACredential: MD
Location Address8484 WANN DR NW STE AMadison, AL 35758-9545
Mailing Address8484 Wann Dr Nw Ste AMadison, AL 35758-9545 · (256) 963-9444 · Fax (256) 963-9446
Phone(256) 963-9444
Fax(256) 963-9446
Sole ProprietorNo
Medical School CMSOtherGraduated 1985
Enumeration DateJanuary 4, 2007
Last NPPES UpdateNovember 17, 20243 updates tracked since enumeration
NPPES CertifiedNovember 17, 2024
✔ NPI 1184771909 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPsychiatry & Neurology · NeurologyAllopathic & Osteopathic Physicians
Taxonomy Code2084N0400X
License✔ Licensed in AL · 28347
Definition
A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures.
Also ListedSpecialistTaxonomy 174400000X · License 28347 (AL)
8484 WANN DR NW STE A, Madison, AL 35758
Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter Health, Ambetter of Alabama, Ambetter of Tennessee and more.Insurance ›

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

Theodros Mengesha Md 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 ID1456434109
PECOS Enrollment IDI20080219000178
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.

Medicare Billing Reassignments

3

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

Tennessee Valley Neurological Associates PC
Same address
Neurology
8484 WANN DR NW STE A
Madison, AL 35758
  • Reassigned Medicare billing, Alabama enrollment
NPI 1538696802 (256) 963-9444
Hh Physicians Network
11 mi
Specialist
101 SIVLEY RD SW
Huntsville, AL 35801
  • Reassigned Medicare billing, Alabama enrollment
  • 182 clinicians in this Medicare group
NPI 1891359683 (256) 801-6036
Athens Neurological
13 mi
Neurological Surgery
700 W MARKET ST
Athens, AL 35611
  • Reassigned Medicare billing, Alabama enrollment
NPI 1467876516 (256) 262-2197

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 13

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 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.
1,140 services701 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.
185 services185 patients
Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes 99223
Initial hospital inpatient care per day, typically 70 minutes, refers to the daily medical service provided to patients admitted to the hospital. This includes a comprehensive evaluation, diagnosis, treatment plan, and monitoring of your health condition. It ensures your well-being during your hospital stay.
169 services162 patients
Measurement of brain wave activity (eeg), awake and asleep 95819
The measurement of brain wave activity, known as an EEG, records the brain's electrical signals. It's performed when you're awake and asleep to monitor your brain's functioning. It helps in diagnosing conditions like epilepsy, sleep disorders, and other neurological issues.
113 services113 patients
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes 99233
Follow-up hospital inpatient care per day typically involves a 35-minute check-up by your healthcare provider. This service includes monitoring your health progress, adjusting your treatment plan if needed, and answering any questions you may have about your condition or care.
109 services107 patients
Measurement of brain wave activity (eeg), awake and asleep 95819
The measurement of brain wave activity, known as an EEG, records the brain's electrical signals. It's performed when you're awake and asleep to monitor your brain's functioning. It helps in diagnosing conditions like epilepsy, sleep disorders, and other neurological issues.
95 services91 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 35758 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
$122.31 typical visit price
range $52.65 – $161.63
Typical copayment $30.57 (range $13.16 – $40.40)
Most-billed visit code 99204
Established Patient
$93.72 typical visit price
range $16.56 – $131.65
Typical copayment $23.43 (range $4.14 – $32.91)
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.

84.33/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality76.96
Improvement Activities40

Reported Quality Measures

Closing the Referral Loop: Receipt of Specialist Report
43%283 patients2/55-star benchmark: 87%
Controlling High Blood Pressure
51%85 patients3/55-star benchmark: 91%
Dementia: Cognitive Assessment
0%39 patients
Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)
Lower rates are better for this measure.
100%52 patients1/55-star benchmark: 91%
Documentation of Current Medications in the Medical Record
91%5,188 patients4/55-star benchmark: 100%
Preventive Care and Screening: Screening for Depression and Follow-Up Plan
0%2,570 patients1/55-star benchmark: 97%
Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented
20%4,183 patients2/55-star benchmark: 61%
Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
Patients screened: 0% · 1,759 patients
0%1,759 patients
Statin Therapy for the Prevention and Treatment of Cardiovascular Disease
76%658 patients3/55-star benchmark: 91%
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

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

TENNESSEE VALLEY NEUROLOGICAL ASSOCIATES PC
Psychiatry & Neurology (Neurology)
8484 WANN DR NW STE A
MADISON, AL 35758
Madison County (256) 963-9444

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 Theodros Mengesha's NPI number?

The NPI number for Theodros Mengesha is 1184771909. It was assigned to this individual provider in the NPPES registry on January 4, 2007.

Where is Theodros Mengesha located?

Theodros Mengesha practices at 8484 Wann Dr NW Ste A, Madison, AL 35758. The listed phone number is (256) 963-9444.

What is Theodros Mengesha's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Neurology, with taxonomy code 2084N0400X.

Is Theodros Mengesha enrolled in Medicare?

Yes. Theodros Mengesha 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 Theodros Mengesha's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Theodros Mengesha reassigns Medicare benefits to 3 organizations: Tennessee Valley Neurological Associates PC (Madison, AL), Hh Physicians Network (Huntsville, AL) and Athens Neurological (Athens, AL). 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 Theodros Mengesha's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Theodros Mengesha accept?

Health plans from Ambetter Health, Ambetter of Alabama, Ambetter of Tennessee, Blue Cross and Blue Shield of Alabama and Oscar Insurance Company list Theodros Mengesha 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.

When was this NPI record last updated?

The NPPES record for Theodros Mengesha was last updated on November 17, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 months 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.