David A Theodoro, M.D.

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

License

28104 Issued in MS

Practice address

12255 De Paul Dr North BLDG
Ste 260
Bridgeton, MO 63044

Phone

(314) 647-8269

Fax

(314) 646-1700

NPI assigned

Jun 20, 2005

Reactivated

Apr 5, 2006

Last updated

Aug 27, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in MO, MS2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Thoracic Surgery

Education

Washington University School of Medicine, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St. Dominic Medical Associates LLCGroup PAC ID 0446303168, 130 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sta Home Health Agency of Jackson, Inc. Dba Accentcare Home Health of Jackson Home health agency, Clinton, MS, CCN 257102
• St Dominic-Jackson Memorial Hospital Hospital, Jackson, MS, CCN 250048

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dtheodoro1646210@direct.casso.us.com

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

• St. Dominic Medical Associates LLC

  • Family Medicine Physician
  • Jackson, MS
  • NPI 1407920549

  Thoracic Surgery (Cardiothoracic Vascular Surgery)

  Medicare reassignment Care Compare group NPD
• SSM Medical Group, Inc.

  dba SSM Health Medical Group

  • Multi-Specialty Clinic/Center
  • Fenton, MO
  • NPI 1700966207
  Medicare reassignment NPD
• SSM Medical Group Inc.

  dba SSM Health Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Warrenton, MO
  • NPI 1467997155
  NPD
• St Dominic Medical Associates LLC

  dba St Dominic Pallative Care

  • Hospitalist Physician
  • Jackson, MS
  • NPI 1285987578
  NPD
• St Dominic Medical Associates LLC

  dba Cardiovascular Surgery Associates

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Jackson, MS
  • NPI 1831342054
  NPD
• SSM Cardiovascular and Thoracic Services, Inc.

  • Cardiovascular Disease Physician
  • Saint Louis, MO
  • NPI 1134400484
  NPD (past)
• Cardiothoracic Surgery Associates, P.C.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Swansea, IL
  • NPI 1073548608
  NPD (past)
• Memorial Management Inc

  • Durable Medical Equipment & Medical Supplies
  • Marion, IL
  • NPI 1518423904
  NPD (past)
• Memorial Management Inc

  • Family Medicine Physician
  • Marion, IL
  • NPI 1720087950
  NPD (past)
• Prairie Cardiovascular Consultants LTD

  • Multi-Specialty Clinic/Center
  • Springfield, IL
  • NPI 1982714218
  NPD (past)
• St Dominic Medical Associates LLC

  dba St. Dominic Family Practice Associates-Jackson

  • Family Nurse Practitioner
  • Jackson, MS
  • NPI 1508263179
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St Dominic-Jackson Memorial Hospital

  • General Acute Care Hospital
  • Jackson, MS
  • NPI 1306876065
  Care Compare affiliation
• Sta-Home Health Agency of Jackson, Inc.

  dba AccentCare Home Health of Jackson

  • Home Health Agency
  • Clinton, MS
  • NPI 1356482749
  Care Compare affiliation

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

{
    "created_epoch": "1119225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598486400000",
    "number": "1073518577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23666",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392253666",
            "telephone_number": "601-200-2780",
            "fax_number": "601-200-2788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12255 DE PAUL DR NORTH BLDG",
            "address_2": "STE 260",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "63044",
            "telephone_number": "314-647-8269",
            "fax_number": "314-646-1700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "970 Lakeland Dr Ste 61",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392164634",
            "country_code": "US",
            "telephone_number": "601-200-2780",
            "fax_number": "601-200-2788",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THEODORO",
        "first_name": "DAVID",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-20",
        "last_updated": "2020-08-27",
        "certification_date": "2020-08-27",
        "deactivation_date": "2006-03-20",
        "reactivation_date": "2006-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "MO",
            "license": "118293",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "IL",
            "license": "036095641",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "MS",
            "license": "28104",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0360957641",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUBSTANCE CONTROL",
            "identifier": "036056372",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "036056372",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BNDD",
            "identifier": "1102596",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036095641",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "118293",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Durwood Alan Tenny, OTR/L
• Sally Terranova, LMSW
• Terry Egan DDS LLC
• The Ambulatory Surgical Center of St. Louis, LP (The Surgical Center of St. Louis)
• The Doretha Buie Center, LLC
• Kristi Lynn Theriot, LPC
• Thomas Gotsis DDS PC
• Jamika Thomas
• Jazell Dailey Thomas, LPC,NCC
• Jocelyn Thomas

• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Bridgeton, MO
• Providers in Bridgeton, MO by specialty
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.