SHANE VERL THEOBALD (CRNA) – Certified Registered Nurse Anesthetist, NPI 1174783492

Certified Registered Nurse Anesthetist

SHANE VERL THEOBALD (CRNA) is a healthcare provider. based in Vernal, Utah. specializing in Certified Registered Nurse Anesthetist. They hold the professional credentials CRNA. They hold a License No. 4938276-4406 (UT). The NPI Number for SHANE VERL THEOBALD (CRNA) is 1174783492

Main info

Male

19 Years Of Experience

Accepts Medicare Assignment

Name

SHANE VERL THEOBALD (CRNA)

NPI

1174783492

Phone

(435) 781-1519

Address

PO BOX 790164

Enumeration Date

10 June 2008

Last Update Date

10 June 2008

Doctor Profile

Medical School Name

OTHER

Secondary Phone

8017146000

Graduation Year

2007 (19 years ago)

PAC ID

9234289737

Group Practice PAC ID

5991604829

Professional Enrollment ID

I20090603000570

Data current as of

20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience48

Completeness75

Years active:17State licenses:1Digital endpointsOther names

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Provider Addresses for SHANE VERL THEOBALD (CRNA)

PO BOX 790164
VERNAL, UT 840790164
Phone: (435) 781-1519
Fax: (435) 781-1519
Type: Mailing
151, West 200 North, Vernal, Uintah County, Utah, 84078, United States
VERNAL, UT 840781907
Phone: (435) 781-1519
Fax: (435) 781-1519
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: 2009-06-03

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

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
I20090603000570	I	Certified Registered Nurse Anesthetist (Crna)	UT	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.

Verify on CMS Revalidation Lookup Tool

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
01402	Anesthesia for procedure for total knee joint replacement	14	14	$0

View full utilization report →

Insurance plans in this area (ZIP 84079)

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Provider's Procedures

SHANE VERL THEOBALD (CRNA) performs procedures in Certified Registered Nurse Anesthetist. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
CERTIFIED REGISTERED NURSE ANESTHET	UT	00142	Anesthesia for lens surgery	23	22

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 5991604829View full group profile

Name	Specialty	State
MR. RICHARD GARY WATTS (CRNA)	Certified Registered Nurse Anesthetist (Crna)	ID
CHERIE CARPENTER BATE (CRNA)	-	UT
SAMANTHA BLAIR WALKER (CRNA)	Certified Registered Nurse Anesthetist (Crna)	UT
COLT BRUNSON (D.O.)	A N E S T H E S I O L O G Y	UT
MATTHEW DAVID NEWBURY (CRNA)	-	UT
JASON D BROTHERSON (A,P.R.N.)	Certified Registered Nurse Anesthetist (Crna)	UT
JARED W OLLERTON (CRNA)	Certified Registered Nurse Anesthetist (Crna)	UT
PAUL B REICHERT (CRNA)	Certified Registered Nurse Anesthetist (Crna)	UT
JACOB MERRILL HUNSAKER (CRNA)	-	UT
JUSTIN CURTIS (APRN-CRNA)	Certified Registered Nurse Anesthetist (Crna)	NE

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Frequently asked questions

What number should I use to identify SHANE VERL THEOBALD (CRNA) for billing?

Administrative and clinical systems typically use NPI 1174783492 for SHANE VERL THEOBALD (CRNA).

Is SHANE VERL THEOBALD (CRNA)'s NPI status active today?

Active status means SHANE VERL THEOBALD (CRNA)'s NPI record is not deactivated in the public file.

Which specialty label fits SHANE VERL THEOBALD (CRNA)?

NPPES ties SHANE VERL THEOBALD (CRNA) to Certified Registered Nurse Anesthetist in the taxonomy section. Clinical services aligned with this taxonomy classification.

Which community is linked to SHANE VERL THEOBALD (CRNA)?

SHANE VERL THEOBALD (CRNA) shows a connection to Vernal, Utah in registry-derived data.

What is the difference between NPI and a medical license?

An NPI is a federal identifier; a medical license is issued by a state and governs where someone may practice.