Matthew R. Theado, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

39636 Issued in WI

Practice address

555 Redbird Cir
Suite 200
De Pere, WI 54115-7977

Phone

(920) 338-6820

Fax

(920) 338-6829

NPI assigned

Aug 9, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mtheado916738@direct.emplifyhealth.org
• Direct secure messaging: mtheado32404@direct.thedacare.org

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.

• Bellin Memorial Hospital Inc

  dba Bellin Health Algoma

  • Rural Health Clinic/Center
  • Algoma, WI
  • NPI 1609838473
  Medicare reassignment NPD
• Bellin Memorial Hospital Inc

  dba Bellin Health

  • Family Medicine Physician
  • Green Bay, WI
  • NPI 1033172390

  Pediatrics

  NPD
• Bellin Memorial Hospital Inc.

  • General Acute Care Hospital
  • Green Bay, WI
  • NPI 1891740585
  NPD
• Bellin Memorial Hospital Inc

  dba FMC Brillion

  • Family Medicine Physician
  • Brillion, WI
  • NPI 1962464784
  NPD (past)

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318291200000",
    "number": "1235149139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 REDBIRD CIR",
            "address_2": "SUITE 200",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541157977",
            "telephone_number": "920-338-6820",
            "fax_number": "920-338-6829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 REDBIRD CIR",
            "address_2": "SUITE 200",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541157977",
            "telephone_number": "920-338-6820",
            "fax_number": "920-338-6829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEADO",
        "first_name": "MATTHEW",
        "middle_name": "R.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2011-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "39636",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32447000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Evan Teske, LAT, ATC
• Amos Thao, LPC
• The Att Center LTD
• The Light Within Therapy LLC
• The Soul Foundry LLC
• Sheila Waldrop Thiel, MD
• Lisa Elaine Thom, MD
• Matthew David Thomas
• Thomas D. Thomas, MS, LPC, CSAT
• Thomas Merrill Thomas, R.PH.

• Pediatrics Physician in De Pere, WI
• Providers in De Pere, WI by specialty
• Pediatrics Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2011; 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.