Individual provider Active NPI

Thomas K Ceballos, MD

  • Diagnostic Radiology Physician
  • Cape Girardeau, MO
National Provider Identifier
1215975719
Registry record updated Dec 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
2024041718 Issued in MO
Practice address
70 Doctors Park
Cape Girardeau, MO 63703-4928
Phone
(573) 335-6671
Fax
(573) 339-0083
NPI assigned
Jun 4, 2006
Last updated
Dec 12, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 74124 WI
Diagnostic Radiology Physician 2085R0202X ME 92981 FL
Diagnostic Radiology Physician 2085R0202X 2024041718 MO Primary

Addresses

Primary practice location

70 Doctors Park
Cape Girardeau, MO 63703-4928

Mailing address

70 Doctors Park
Cape Girardeau, MO 63703-4928
Phone (573) 335-6671

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IA, WI, IL, KY5 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 5

Enrollment IDStateProvider typePAC IDDetails
I20150630001636 MO Practitioner - Diagnostic Radiology 7719089242 Reassigns benefits to 3 organizations
I20201105001807 IA Practitioner - Diagnostic Radiology 7719089242 Reassigns benefits to 4 organizations
I20201117000723 WI Practitioner - Diagnostic Radiology 7719089242 Reassigns benefits to 12 organizations
I20241031000311 IL Practitioner - Diagnostic Radiology 7719089242 Reassigns benefits to 1 organization
I20241111003495 KY Practitioner - Diagnostic Radiology 7719089242 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Minnesota Medical School, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cape Radiology Group PCGroup PAC ID 9830093236, 54 clinicians
Mercy Hospital PerryGroup PAC ID 1153777826, 115 clinicians

Practice addresses (Care Compare)

1530 Lone Oak Rd
Paducah, KY 42003-7901
Phone (270) 444-2444

211 Saint Francis Dr
Cape Girardeau, MO 63703-5049
Phone (573) 331-3000

405 W Jackson St
Carbondale, IL 62901-1462
Phone (618) 549-0721

434 N W St
Perryville, MO 63775-1359
Phone (573) 547-2536

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
74124WIMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Black River Health Inc CurrentSince Jan 1, 2021 Accepting new patients
Mercy Hospital Perry Diagnostic Radiology CurrentSince Mar 21, 2025 Accepting new patients
Tri-County Memorial Hospital, Inc. CurrentSince Nov 24, 2020 Accepting new patients
St. Joseph's Health Services, Inc. CurrentSince Nov 19, 2020 Accepting new patients
Veterans Memorial Hospital City of Waukon Ia Current Accepting new patients
Tomah Memorial Hospital Inc CurrentSince Dec 1, 2023 Accepting new patients
Gundersen Lutheran Medical Center Inc Current Accepting new patients
Veterans Memorial Hospital City of Waukon Ia CurrentSince Jul 1, 2022 Accepting new patients
Black River Health Inc CurrentSince Jan 1, 2021 Accepting new patients
Saint Elizabeths Hospital of Wabasha Inc CurrentSince May 26, 2021 Accepting new patients
Tri-County Memorial Hospital, Inc. Current Accepting new patients
Veterans Memorial Hospital City of Waukon Ia CurrentSince Jul 1, 2022 Accepting new patients
Veterans Memorial Hospital City of Waukon Ia Current Accepting new patients
Memorial Hospital of Boscobel CurrentSince Nov 3, 2020 Accepting new patients
Vernon Memorial Healthcare, Inc. CurrentSince Jan 1, 2021 Accepting new patients
Mercy Hospital Perry CurrentSince Mar 21, 2025 Accepting new patients
Saint Elizabeths Hospital of Wabasha Inc Current Accepting new patients
Tri-County Memorial Hospital, Inc. CurrentSince Nov 24, 2020 Accepting new patients
Moundview Memorial Hospital & Clinics, Inc. CurrentSince Nov 17, 2020 Accepting new patients
St. Joseph's Health Services, Inc. CurrentSince Nov 19, 2020 Accepting new patients
Moundview Memorial Hospital & Clinics, Inc Current Accepting new patients
Memorial Hospital of Boscobel CurrentSince Nov 3, 2020 Accepting new patients
Boone Physician Services, LLC CurrentSince Dec 1, 2024 Accepting new patients
Black River Health Inc Current Accepting new patients
Gundersen Clinic LTD CurrentSince Nov 3, 2020 Accepting new patients
Moundview Memorial Hospital & Clinics, Inc. CurrentSince Nov 17, 2020 Accepting new patients
Palmer Lutheran Health Center, Inc. CurrentSince Jan 27, 2021 Accepting new patients
Tomah Memorial Hospital Inc Diagnostic Radiology CurrentSince Dec 1, 2023 Accepting new patients
Citrus Memorial Health Foundation Inc Past Accepting new patients
Medical Specialist Associates of Florida LLC Past Accepting new patients

Locations

1830 State Highway 9
Decorah, IA 52101
Phone (563) 382-2639

40 1st St SE
Waukon, IA 52172
Phone (563) 568-3411

112 Jefferson St
West Union, IA 52175
Phone (563) 422-3811

405 W Jackson St
Carbondale, IL 62901

123 5th Ave SE
Spring Grove, MN 55974
Phone (507) 498-3302

1200 Grant Blvd W
Wabasha, MN 55981
Phone (651) 565-4531

1600 E Broadway
Columbia, MO 65201
Phone (573) 632-5000

434 N West St
Perryville, MO 63775
Phone (573) 547-2530

711 W Adams St
Blk River Fls, WI 54615
Phone (715) 284-1302

205 Parker St
Boscobel, WI 53805
Phone (608) 375-4112

402 W Lake St
Friendship, WI 53934
Phone (608) 339-3331

1836 South Ave
La Crosse, WI 54601
Phone (608) 788-8102

1836 South Ave
#301
La Crosse, WI 54601

1910 South Ave
La Crosse, WI 54601
Phone (608) 775-2287

610 E Taylor St
Prairie du Chien, WI 53821
Phone (608) 326-6466

501 Gopher Dr
Tomah, WI 54660
Phone (608) 371-2181

407 S Main St
Ste 400
Viroqua, WI 54665
Phone (608) 637-3174

507 S Main St
Viroqua, WI 54665
Phone (608) 637-2101

18601 Lincoln St
Whitehall, WI 54773
Phone (715) 538-1712

Networks

  • Freedom Health HMO Network

Organizations & group practices 31

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.

View all 31

Hospital & facility affiliations 7

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": "1149379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733961600000",
    "number": "1215975719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 DOCTORS PARK",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637034928",
            "telephone_number": "573-335-6671",
            "fax_number": "573-339-0083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 DOCTORS PARK",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637034928",
            "telephone_number": "573-335-6671",
            "fax_number": "573-339-0083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CEBALLOS",
        "first_name": "THOMAS",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-04",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WI",
            "license": "74124",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "ME 92981",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "2024041718",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cape Girardeau, MO

Sources for this page

Verify at the official NPI Registry.