BENJAMIN WATERS THEISEN DO
NPI 1235718529
Student in an Organized Health Care Education/Training Program in Little Rock, AR

Q: What is Benjamin Theisen's NPI number?

The NPI number for Benjamin Theisen is 1235718529. It was assigned to this individual provider in the NPPES registry on April 5, 2021.

Q: What is Benjamin Theisen's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Benjamin Theisen was last updated on June 27, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.

Active since April 05, 2021PECOS Enrolled

1 CHILDRENS WAY # 512-19A, LITTLE ROCK, AR 72202(501) 364-1874 Get Directions Write a Review

NPPES record last updated: June 27, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 27, 2024, Apr 5, 2021 (2 updates tracked since 2021).

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About Benjamin Waters Theisen Do NPPES

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

BENJAMIN WATERS THEISEN DO (NPI 1235718529) is an individual student in an organized health care education/training program in Little Rock, Arkansas and active in the NPI registry since April 2021. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1235718529

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameBENJAMIN WATERS THEISENCredential: DO

Location Address1 CHILDRENS WAY # 512-19ALittle Rock, AR 72202-3500

Mailing Address1 Childrens Way # 512-3Little Rock, AR 72202-3500 · (501) 364-2012

Phone(501) 364-1874

Sole ProprietorYes

Enumeration DateApril 5, 2021

Last NPPES UpdateJune 27, 20242 updates tracked since enumeration

NPPES CertifiedJune 27, 2024

✔ NPI 1235718529 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

1 CHILDRENS WAY # 512-19A, Little Rock, AR 72202

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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)

Benjamin Waters Theisen Do 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.

Other Providers at the Same Location NPPES 20

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

MR. JONATHAN L ASKINS JR. MD

Student in an Organized Health Care Education/Training Program