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BLAKE ORION THEABOLD DO
NPI 1568216596
Student in an Organized Health Care Education/Training Program in Corpus Christi, TX

Active since April 16, 2024PECOS Enrolled
600 ELIZABETH ST # 9B9.209, CORPUS CHRISTI, TX 78404(361) 861-1864 Get Directions Write a Review

NPPES record last updated: May 8, 2026. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: May 8, 2026, Apr 16, 2024 (2 updates tracked since 2024).

About Blake Orion Theabold Do NPPES

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

BLAKE ORION THEABOLD DO (NPI 1568216596) is an individual student in an organized health care education/training program in Corpus Christi, Texas and active in the NPI registry since April 2024. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1568216596
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameBLAKE ORION THEABOLDCredential: DO
Location Address600 ELIZABETH ST # 9B9.209Corpus Christi, TX 78404-2235
Mailing Address600 Elizabeth St # 9b9.209Corpus Christi, TX 78404-2235
Phone(361) 861-1864
Sole ProprietorNo
Enumeration DateApril 16, 2024
Last NPPES UpdateMay 8, 20262 updates tracked since enumeration
NPPES CertifiedMay 8, 2026
✔ NPI 1568216596 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ 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.
Also ListedEmergency MedicineTaxonomy 207P00000X · License W5584 (TX)
600 ELIZABETH ST # 9B9.209, Corpus Christi, TX 78404
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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)

Blake Orion Theabold 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.

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 Blake Theabold's NPI number?

The NPI number for Blake Theabold is 1568216596. It was assigned to this individual provider in the NPPES registry on April 16, 2024.

Where is Blake Theabold located?

Blake Theabold practices at 600 Elizabeth St # 9b9.209, Corpus Christi, TX 78404. The listed phone number is (361) 861-1864.

What is Blake Theabold's specialty?

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

Is Blake Theabold enrolled in Medicare?

Yes. Blake Theabold is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Blake Theabold was last updated on May 8, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.