MR. GEOFFREY J THEOBALD (P.A.-C) – Physician Assistant, NPI 1780642082
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
4,031 PHYSICIAN ASSISTANT in MN
Provider Addresses for MR. GEOFFREY J THEOBALD (P.A.-C)
1700 UNIVERSITY AVE W
SAINT PAUL, MN 551043727
Phone:
Type: Mailing
Koch Industries, Inc. | Lehigh Consumer Group, LLC, 4200, Dahlberg Drive, Glenwood Junction, Golden Valley, Hennepin County, Minnesota, 55422, United States
SUITE 300
GOLDEN VALLEY, MN 554224840
Phone: (952) 512-5600
Fax: (952) 512-5651
Type: Mailing
1000, 140th Street West, Burnsville, Dakota County, Minnesota, 55337, United States
SUITE 201
BURNSVILLE, MN 553374480
Phone: (952) 898-6300
Fax: (952) 898-6035
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2004-06-30
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 |
|---|---|---|---|---|
| I20040630000771 | I | Physician Assistant | MN | 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 |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 76 | 66 | $0 |
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 40 | 40 | $0 |
| 63047 | Partial removal of spine bone with release of lower spinal cord and/or nerves, 1 segment | 13 | 13 | $0 |
Insurance plans in this area (ZIP 55104)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| P A T H O L O G Y | MN | |
| G A S T R O E N T E R O L O G Y | MN | |
| N E U R O S U R G E R Y | OH | |
| - | MN | |
| Physician Assistant | MN | |
| Physician Assistant | MN | |
| - | MN | |
| - | MN | |
| Physical Therapist In Private Practice | OR | |
| Cardiovascular Disease (Cardiology) | IL |
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