Blair A Theis

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

2013035893 Issued in MO

Practice address

35 Goodwin Dr
Festus, MO 63028-4122

Phone

(636) 933-4141

Fax

(636) 931-7007

NPI assigned

Sep 20, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ccpartners LLC

  • Pediatric Adolescent Medicine Physician
  • Festus, MO
  • NPI 1487857033
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1568937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645660800000",
    "number": "1013568120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 GOODWIN DR",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "630284122",
            "telephone_number": "636-933-4141",
            "fax_number": "636-931-7007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 GOODWIN DR",
            "city": "FESTUS",
            "state": "MO",
            "postal_code": "630284122",
            "telephone_number": "636-933-4141",
            "fax_number": "636-931-7007"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1309 Maple St",
            "address_purpose": "LOCATION",
            "city": "Farmington",
            "state": "MO",
            "postal_code": "636407641",
            "country_code": "US",
            "telephone_number": "573-756-4343",
            "fax_number": "573-756-7191",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Childrens Pl",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631101002",
            "country_code": "US",
            "telephone_number": "314-454-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THEIS",
        "first_name": "BLAIR",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-20",
        "last_updated": "2022-02-24",
        "certification_date": "2022-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MO",
            "license": "2013035893",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "daniel.rudolph@kbp.eclinicaldirect.com",
            "affiliation": "Y",
            "endpointDescription": "Practice direct message",
            "affiliationName": "CCPartners LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "35 Goodwin Dr",
            "city": "Festus",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630284122",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1 Childrens Pl",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631101002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Clarence A Temple, MD
• Barbara A Tenholder
• Tobias Mark Terhaar, DC
• Loc Vinh Thang, MD
• The Caring Corner Inc.
• Amy Kovac Thomas, PLPC
• Michelle Thomas
• Norinee Jean Thomas
• Shannon Thomas, LMSW
• Brienna Thompson, LPC

• Pediatric Nurse Practitioner in Festus, MO
• Providers in Festus, MO by specialty
• Pediatric Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.