NPIMap

Individual provider Active NPI

Maxine A Theriot, MD

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • Poplar Bluff, MO
National Provider Identifier
1194874628
Registry record updated Jul 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Undersea and Hyperbaric Medicine (Preventive Medicine) PhysicianTaxonomy code 2083P0011X
License
2022047286 Issued in MO
Practice address
3098 Oak Grove Rd
Poplar Bluff, MO 63901-8938
Phone
(573) 686-8199
Fax
(573) 686-8398
NPI assigned
Jan 10, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X J9578 TX
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician 2083P0011X J9578 TX
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician 2083P0011X 2022047286 MO Primary

Addresses

Primary practice location

3098 Oak Grove Rd
Poplar Bluff, MO 63901-8938

Mailing address

709 W Rusk St Ste B
Rockwall, TX 75087-3600
Phone (972) 786-0140

Other practice location 1

1650 W College St
Grapevine, TX 76051-3565
Phone (972) 816-0459

Other names 1

  • Maxine A Dawes Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, MO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20070517000348 TX Practitioner - Family PracticePractitioner - Undersea and Hyperbaric Medicine 0648296525
I20230322000964 MO Practitioner - Family PracticePractitioner - Undersea and Hyperbaric Medicine 0648296525 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Undersea and Hyperbaric Medicine
Education
Loma Linda University School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poplar Bluff Hma Physician Management, LLCGroup PAC ID 5092769703, 41 clinicians

Practice addresses (Care Compare)

3098 Oak Grove Rd
Poplar Bluff, MO 63901-8938
Phone (855) 444-7276

Hospital & facility affiliations

  • Ozark Home Healthcare Home health agency, Poplar Bluff, MO, CCN 267662
  • Comfort Care Home Health Agency, Inc Home health agency, Doniphan, MO, CCN 267522
  • Elara Caring Home health agency, Dexter, MO, CCN 267589
  • Poplar Bluff Regional Medical Center Hospital, Poplar Bluff, MO, CCN 260119
  • Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242
  • Saint Francis Medical Center Hospital, Cape Girardeau, MO, CCN 260183
  • Mercy Hospital Stoddard Hospital, Dexter, MO, CCN 260160
  • Missouri Delta Medical Center Hospital, Sikeston, MO, CCN 260113

Merit-based Incentive Payment System (MIPS)

Final score
91.41 of 100Reported as apm
Quality
79.26
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue813
Removal of skin lesions35
Removal of nail tissue1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2588WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Poplar Bluff Hma Physician Management, LLC Family Medicine CurrentSince Mar 1, 2023 Accepting new patients

Locations

3098 Oak Grove Rd
Poplar Bluff, MO 63901
Phone (573) 778-2600

3100 Oak Grove Rd
Rombauer, MO 63901
Phone (573) 776-2000

Organizations & group practices 1

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.

Hospital & facility affiliations 10

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

NPI Registry JSON

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689206400000",
    "number": "1194874628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 W RUSK ST STE B",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "750873600",
            "telephone_number": "972-786-0140",
            "fax_number": "972-786-0142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3098 OAK GROVE RD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639018938",
            "telephone_number": "573-686-8199",
            "fax_number": "573-686-8398"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1650 W College St",
            "address_purpose": "LOCATION",
            "city": "Grapevine",
            "state": "TX",
            "postal_code": "760513565",
            "country_code": "US",
            "telephone_number": "972-816-0459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THERIOT",
        "first_name": "MAXINE",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-10",
        "last_updated": "2023-07-13",
        "certification_date": "2023-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "J9578",
            "primary": false
        },
        {
            "code": "2083P0011X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": "TX",
            "license": "J9578",
            "primary": false
        },
        {
            "code": "2083P0011X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": "MO",
            "license": "2022047286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MAXINE",
            "last_name": "DAWES",
            "middle_name": "A",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Poplar Bluff, MO

Sources for this page

Verify at the official NPI Registry.