THEODORE NOBLE SMITH (PA-C) – Physician Assistant, NPI 1255333704
Physician Assistant
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Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,648 PHYSICIAN ASSISTANT in IA
Provider Addresses for THEODORE NOBLE SMITH (PA-C)
1836, South Avenue, La Crosse, La Crosse County, Wisconsin, 54601, United States
LA CROSSE, WI 546015429
Phone: (608) 782-7300
Type: Mailing
5409 Avenue O
Fort Madison, IA 526279601
Phone: (319) 376-2134
Fax: (319) 376-2188
Type: Location
112 Jefferson St
West Union, IA 52175
Phone: (563) 422-3811
Type: Location
100 County Road B
Shawano, WI 541667072
Phone: (715) 526-2111
Fax: (715) 526-9366
Type: Location
800 Riverside Dr
Waupaca, WI 549811943
Phone: (715) 258-1000
Fax: (715) 258-1042
Type: Location
4850 100th St
Urbandale, IA 503227212
Phone: (515) 224-1414
Fax: (515) 224-5140
Type: Location
6001 Westown Pkwy
West Des Moines, IA 502667702
Phone: (515) 224-1414
Fax: (515) 224-5140
Type: Location
350 NE 36TH ST
ANKENY, IA 500216728
Phone: (515) 224-1414
Fax: (515) 224-5140
Type: Location
112, Jefferson Street, Clayton, Union County, New Mexico, 88415, United States
WEST UNION, IA 52175
Phone: (563) 422-3811
Type: Location
6001 WESTOWN PKWY
WEST DES MOINES, IA 502667702
Phone: (515) 224-1414
Type: Mailing
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: 2018-12-12
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20050118000720 | I | Physician Assistant | IA | TBD |
| I20181212001298 | I | Physician Assistant | WI | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 54601)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | IA | |
| Nurse Practitioner | IA | |
| Physical Therapist In Private Practice | IA | |
| Physician Assistant | IA | |
| - | IA | |
| Orthopedic Surgery | IA | |
| Physician Assistant | IA | |
| Physical Medicine And Rehabilitation | IA | |
| Orthopedic Surgery | IA | |
| Occupational Therapist In Private Practice | IA |
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