DR. SHOBA THEIVANAYAGAM (M.D) – Gastroenterology Physician, NPI 1730388067
Gastroenterology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
161 GASTROENTEROLOGY in IA
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Provider Addresses for DR. SHOBA THEIVANAYAGAM (M.D)
5105, North Glen Park Pl Road, Peoria, Peoria County, Illinois, 61614, United States
PEORIA, IL 616144675
Phone: (309) 308-5900
Fax: (309) 308-5910
Type: Mailing
102, East Jefferson Street, Iowa City, Johnson County, Iowa, 52245, United States
IOWA CITY, IA 522452460
Phone: (319) 337-5997
Type: Location
PO BOX 782009
ORLANDO, FL 328782009
Phone: (407) 201-3686
Fax: (407) 201-3739
Type: Mailing
812 W OAK ST
KISSIMMEE, FL 347416625
Phone: (407) 201-3686
Fax: (407) 201-3739
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 35 Open Payments records for all available years, with a total value of $643.
Total Amount is formed as General ($643) + Research ($0) + Ownership ($0) = $643.
Last reported payment date: 2024-12-02 • Largest payer in this snapshot: ABBVIE INC. ($349).
Total Amount
$643
General + Research + Ownership
Payments
35
Total payment records
General Amount
$643
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-02
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $349 |
| Phathom Pharmaceuticals, Inc. | $90 |
| Madrigal Pharmaceuticals | $53 |
| Janssen Biotech, Inc. | $44 |
| Ardelyx, Inc. | $28 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2021-05-21
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20210521002131 | I | Gastroenterology | FL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 136 | 81 | $0 |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 62 | 62 | $0 |
Insurance plans in this area (ZIP 61614)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| GASTROENTEROLOGY | IA | 43235 | Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope | 55 | 53 |
| GASTROENTEROLOGY | IA | 45378 | Diagnostic examination of large bowel using an endoscope | 22 | 22 |
| GASTROENTEROLOGY | IA | 45385 | Removal of polyps or growths of large bowel using an endoscope | 84 | 84 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| G A S T R O E N T E R O L O G Y | FL | |
| Physician Assistant | FL | |
| Physician Assistant | FL |
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