Active NPI 1497742514 Individual Practitioner Male Practitioner

Dr. Marc A Theroux , MD

Internal Medicine • Fall River, MA

Professional Overview & Biography Verified Profile Summary

Dr. Marc Theroux, MD is a registered healthcare professional specializing in Internal Medicine in Fall River, MA. Practice services are available at 534 PROSPECT ST under active NPI credentials.

Frequently performed procedures and clinical services include established patient outpatient office visit, chronic care management services, first, chronic care management services for two or more chronic conditions, additional. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

534 Prospect St

Fall River, MA 027205239

Telephone 5089737766

Fax 5089737753

Associated Practice Facility / Clinic

🏢 New Bedford Medical Associates Pc Facility NPI 1093783417

Specialty Benchmarks & Practice Insights

Comparative analytics for Internal Medicine in Fall River, MA

Active Practitioner

Practitioner Clinical Experience

Active

City Avg: 28.4 Yrs

State Avg: 29.3 Yrs

Regional Practice Density

68 Specialists

Practicing in Fall River, MA (7127 Statewide)

Telehealth Adoption Rate

41.2% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

66.1% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	506	391	$392.06	$136.11
99490 Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month	431	68	$195.06	$66.59
99439 Chronic care management services for two or more chronic conditions, additional 20 minutes of clinical staff time directed by health care professional, per calendar month	165	46	$147.24	$50.68
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	33	31	$171.12	$57.97
99213 Established patient office or other outpatient visit, typically 15 minutes	25	25	$278.00	$93.85
93000 Routine ekg using at least 12 leads including interpretation and report	24	23	$54.00	$15.26
G0008 Administration of influenza virus vaccine	23	22	$147.91	$31.38
99487 Complex chronic care management services for two or more chronic conditions, first 60 minutes of clinical staff time directed by health care professional, per calendar month	19	16	$407.68	$144.40
90653 Vaccine for influenza for injection into muscle	16	16	$210.00	$81.82

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	651	457	$392.00	$131.81
99490 Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month	574	75	$193.00	$64.38
99439 Chronic care management services for two or more chronic conditions, additional 20 minutes of clinical staff time directed by health care professional, per calendar month	490	75	$146.00	$48.92
G0008 Administration of influenza virus vaccine	76	73	$144.00	$31.47
90694 Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage	69	67	$139.09	$74.84
36415 Insertion of needle into vein for collection of blood sample	68	49	$12.00	$8.40
99487 Complex chronic care management services for two or more chronic conditions, first 60 minutes of clinical staff time directed by health care professional, per calendar month	61	36	$406.00	$137.77
99213 Established patient office or other outpatient visit, typically 15 minutes	45	40	$278.00	$93.73
93000 Routine ekg using at least 12 leads including interpretation and report	37	36	$54.00	$15.05
99489 Complex chronic care management services for two or more chronic conditions, each additional 60 minutes of clinical staff time directed by health care professional, per calendar month	35	17	$213.00	$72.81
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	26	22	$169.00	$54.45
G0009 Administration of pneumococcal vaccine	15	15	$144.00	$31.47
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	14	14	$174.00	$58.93
90677 Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use	14	14	$567.71	$281.16
99348 Residence visit for established patient with low level of medical decision making, per day, if using time, at least 30 minutes	13	13	$265.00	$78.15

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	743	474	$385.60	$133.87
99490 Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month	704	101	$147.38	$66.17
99439 Chronic care management services for two or more chronic conditions, additional 20 minutes of clinical staff time directed by health care professional, per calendar month	494	92	$123.89	$49.89
G0008 Administration of influenza virus vaccine	110	110	$126.38	$30.82
90694 Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage	98	98	$129.18	$69.53
99489 Complex chronic care management services for two or more chronic conditions, each additional 60 minutes of clinical staff time directed by health care professional, per calendar month	96	24	$167.38	$73.33
99213 Established patient office or other outpatient visit, typically 15 minutes	93	73	$270.77	$95.72
36415 Insertion of needle into vein for collection of blood sample	78	50	$12.00	$2.96
99487 Complex chronic care management services for two or more chronic conditions, first 60 minutes of clinical staff time directed by health care professional, per calendar month	78	41	$324.21	$135.17
93000 Routine ekg using at least 12 leads including interpretation and report	58	57	$54.00	$14.85
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	27	23	$169.00	$55.93
99308 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 15 minutes	19	11	$219.00	$71.25
G0009 Administration of pneumococcal vaccine	18	18	$104.33	$31.01
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	13	11	$541.77	$189.85
99348 Residence visit for established patient with low level of medical decision making, per day, if using time, at least 30 minutes	13	12	$265.00	$85.69
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	13	13	$168.92	$59.76

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99490 Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month	985	202	$131.00	$43.03
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	805	506	$354.30	$136.51
99439 Chronic care management services for two or more chronic conditions, additional 20 minutes of clinical staff time directed by health care professional, per calendar month	586	169	$111.00	$39.11
G0008 Administration of influenza virus vaccine	148	148	$91.96	$17.86
90662 Influenza vaccine split virus, preservative free	137	137	$119.23	$64.69
99213 Established patient office or other outpatient visit, typically 15 minutes	116	102	$247.93	$96.77
36415 Insertion of needle into vein for collection of blood sample	88	58	$12.00	$3.00
93000 Routine ekg using at least 12 leads including interpretation and report	62	59	$54.00	$15.71
99487 Complex chronic care management services for two or more chronic conditions, first 60 minutes of clinical staff time directed by health care professional, per calendar month	60	41	$290.00	$89.65
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	52	49	$169.00	$56.17
G0009 Administration of pneumococcal vaccine	31	31	$91.26	$17.83
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	23	23	$241.57	$118.10
99348 Residence visit for established patient with low level of medical decision making, per day, if using time, at least 30 minutes	23	21	$265.00	$87.22
99349 Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes	18	15	$406.00	$134.65
99442 Telephone medical discussion with physician, 11-20 minutes	18	18	$260.00	$97.14
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	14	13	$493.71	$191.87
90682 Influenza vaccine, quadrivalent derived from recombinant dna	12	12	$118.67	$59.11

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99490 Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month	1,540	231	$131.81	$44.05
G2058 Chronic care management services, each additional 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (list separately in addition to code for primary procedure). (do not report g2058 fo	589	179	$118.00	$39.32
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	573	415	$345.00	$115.10
99443 Telephone medical discussion with physician, 21-30 minutes	195	173	$370.22	$115.84
G0008 Administration of influenza virus vaccine	141	137	$84.68	$17.75
90662 Influenza vaccine split virus, preservative free	134	130	$110.43	$60.07
99442 Telephone medical discussion with physician, 11-20 minutes	119	111	$251.41	$79.88
99487 Complex chronic care management services for two or more chronic conditions, first 60 minutes of clinical staff time directed by health care professional, per calendar month	72	55	$292.42	$94.78
99213 Established patient office or other outpatient visit, typically 15 minutes	63	58	$236.63	$79.91
99489 Complex chronic care management services for two or more chronic conditions, each additional 60 minutes of clinical staff time directed by health care professional, per calendar month	59	25	$145.19	$46.88
93000 Routine ekg using at least 12 leads including interpretation and report	55	53	$54.76	$18.21
G0009 Administration of pneumococcal vaccine	47	46	$79.22	$17.66
36415 Insertion of needle into vein for collection of blood sample	47	35	$12.00	$2.98
99307 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 10 minutes	43	14	$139.00	$46.51
99348 Residence visit for established patient with low level of medical decision making, per day, if using time, at least 30 minutes	34	26	$265.00	$88.84
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	33	28	$169.76	$56.95
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	28	28	$232.71	$117.07
G0179 Physician re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imp	25	12	$131.44	$43.75
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	23	13	$289.83	$96.65
99349 Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes	20	19	$407.90	$136.42
90670 Pneumococcal vaccine for injection into muscle	15	15	$446.47	$208.19
99441 Telephone medical discussion with physician, 5-10 minutes	14	14	$160.00	$48.60
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	13	13	$462.00	$145.37
99496 Transitional care management services for problem of high complexity	12	12	$752.83	$260.55

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99490 Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month	2,092	287	$115.69	$43.77
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,069	557	$301.23	$114.10
G0008 Administration of influenza virus vaccine	187	181	$86.82	$17.42
90662 Influenza vaccine split virus, preservative free	167	161	$104.09	$54.70
99307 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 10 minutes	114	23	$124.08	$46.17
36415 Insertion of needle into vein for collection of blood sample	107	57	$11.26	$2.94
99213 Established patient office or other outpatient visit, typically 15 minutes	68	60	$199.56	$78.42
G0009 Administration of pneumococcal vaccine	66	65	$102.91	$17.42
93000 Routine ekg using at least 12 leads including interpretation and report	63	63	$47.22	$18.09
99489 Complex chronic care management services for two or more chronic conditions, each additional 60 minutes of clinical staff time directed by health care professional, per calendar month	47	19	$128.21	$48.53
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	45	43	$408.96	$153.38
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	44	40	$152.20	$56.28
99348 Residence visit for established patient with low level of medical decision making, per day, if using time, at least 30 minutes	42	25	$228.14	$88.03
99487 Complex chronic care management services for two or more chronic conditions, first 60 minutes of clinical staff time directed by health care professional, per calendar month	40	34	$252.50	$97.08
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	38	38	$219.79	$110.43
90670 Pneumococcal vaccine for injection into muscle	28	28	$417.50	$206.01
90682 Influenza vaccine, quadrivalent derived from recombinant dna	20	20	$106.30	$54.89
99496 Transitional care management services for problem of high complexity	16	15	$655.19	$244.37
99495 Transitional care management services for problem of at least moderate complexity	12	12	$458.25	$173.31
99305 Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes	11	11	$362.27	$136.47

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,063	575	$283.08	$111.99
99490 Chronic care management services, first 20 minutes of clinical staff time directed by health care professional, per calendar month	287	145	$112.00	$43.96
G0008 Administration of influenza virus vaccine	190	189	$115.53	$21.55
90662 Influenza vaccine split virus, preservative free	162	162	$90.44	$51.98
99307 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 10 minutes	147	28	$116.36	$46.38
99213 Established patient office or other outpatient visit, typically 15 minutes	124	102	$192.32	$76.54
93000 Routine ekg using at least 12 leads including interpretation and report	89	86	$45.00	$17.70
36415 Insertion of needle into vein for collection of blood sample	79	46	$9.43	$2.94
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	63	55	$142.13	$56.33
G0009 Administration of pneumococcal vaccine	58	58	$108.57	$21.55
90670 Pneumococcal vaccine for injection into muscle	39	39	$316.92	$191.47
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	32	17	$238.75	$95.29
99348 Residence visit for established patient with low level of medical decision making, per day, if using time, at least 30 minutes	28	19	$219.54	$87.55
G0179 Physician re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imp	26	14	$109.46	$43.85
99496 Transitional care management services for problem of high complexity	25	21	$608.32	$243.21
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	24	24	$379.17	$151.73
99495 Transitional care management services for problem of at least moderate complexity	21	18	$432.00	$164.72
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	21	21	$179.90	$100.56
90682 Influenza vaccine, quadrivalent derived from recombinant dna	19	19	$87.95	$52.30
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	13	12	$115.31	$46.32
99304 Initial nursing facility care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes	12	12	$238.00	$94.76

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,031	548	$271.88	$110.54
G0008 Administration of influenza virus vaccine	203	196	$92.45	$26.66
90662 Influenza vaccine split virus, preservative free	172	172	$62.69	$48.05
99307 Subsequent nursing facility care with straightforward level of medical decision making, per day, if using time, at least 10 minutes	163	35	$110.55	$45.84
99213 Established patient office or other outpatient visit, typically 15 minutes	128	100	$182.63	$75.63
36415 Insertion of needle into vein for collection of blood sample	117	36	$16.71	$2.94
G0009 Administration of pneumococcal vaccine	50	50	$88.72	$26.66
G0180 Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and	42	37	$140.62	$55.73
99348 Residence visit for established patient with low level of medical decision making, per day, if using time, at least 30 minutes	38	25	$213.47	$86.51
99496 Transitional care management services for problem of high complexity	37	34	$426.86	$232.91
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	32	30	$366.13	$149.08
90670 Pneumococcal vaccine for injection into muscle	29	29	$289.00	$187.22
99309 Subsequent nursing facility care with moderate level of medical decision making, per day, if using time, at least 30 minutes	24	14	$225.96	$93.78
99495 Transitional care management services for problem of at least moderate complexity	24	24	$303.33	$169.08
90688 Vaccine for influenza for administration into muscle, 0.5 ml dosage	23	22	$38.48	$17.48
90732 Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older	21	21	$127.05	$93.96
G0179 Physician re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imp	19	11	$107.53	$43.11
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	18	18	$111.94	$45.37
99305 Initial nursing facility care with moderate level of medical decision making, per day, if using time, at least 35 minutes	15	15	$325.80	$133.48

Medical Specialties & State Licenses

CMS Verified: 2020-04-27

Internal Medicine Primary Specialty

NUCC Taxonomy Code: 207R00000X

State License MA 72558

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Internal Medicine

NUCC Taxonomy Code: 207R00000X

State License RI MD08048

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID

110048792A (MA)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

11 Associated Practitioners

Dr. Kimberly Babb , MD

Internal Medicine

NPI 1134342298

Doctor of Medicine (M.D.)

Fatima Medeiros

Nurse Practitioner

NPI 1144757998

Dr. Lucas Ryback , MD

Internal Medicine

NPI 1164582508

Doctor of Medicine (M.D.)

Dr. Bamidele Fagbola , DNP, AGPCNP

Nurse Practitioner

NPI 1265002075

Doctor of Nursing Practice, AGPCNP

Dr. Michael Roberts , MD

Internal Medicine

NPI 1265787238

Doctor of Medicine (M.D.)

Dr. Warren Wood , MD

Internal Medicine

NPI 1285621300

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events

✅

NPI Profile Active February 17, 2016

NPI status registered as active in NPPES database

📍

Updated Practice Location February 17, 2016

Registered at 534 PROSPECT ST, FALL RIVER, MA 027205239 (Tel: 5089737766)

📍

Updated Business Mailing Address February 17, 2016

Registered at 200 MILL RD, STE 180, FAIRHAVEN, MA 027195252 (Tel: 5089732000)

👤

Provider Name / Credentials Updated February 17, 2016

Recorded as MARC THEROUX, MD

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) February 17, 2016

Internal Medicine (License #72558 in MA)

🟢

Initial NPI Registration & Enumeration October 04, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1497742514

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: October 04, 2005

Last Update: April 27, 2020

Sole Proprietor: No

Update or Correct Profile

Mailing Address

200 Mill Rd, Ste 180

Fairhaven, MA 027195252

Phone: 5089732000

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.