NPIMap

Individual provider Active NPI

Julie A Theis, M.D.

  • Family Medicine Physician
  • Superior, NE
National Provider Identifier
1295712842
Registry record updated Sep 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
21928 Issued in NE
Practice address
525 E 11TH St
Superior, NE 68978-1101
Phone
(402) 879-4781
Fax
(402) 879-3365
NPI assigned
Dec 26, 2005
Last updated
Sep 9, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 21928 NE Primary

Addresses

Primary practice location

525 E 11TH St
Superior, NE 68978-1101

Mailing address

PO Box 407
Superior, NE 68978-0407
Phone (402) 879-4781

Other identifiers 1

IdentifierTypeStateIssuer
47038801213MedicaidNE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address JulieTheis@bmh.securechart.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050718000456 NE Practitioner - Family Practice 0042247439 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Nebraska College of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Brodstone Memorial HospitalGroup PAC ID 4082513015, shared by 5 NPIs, 12 clinicians

Practice addresses (Care Compare)

520 E 10TH St
Superior, NE 68978-1225
Phone (402) 879-3281

5427 Hwy 136
Brodstone Family Medical Center Deshler
Deshler, NE 68340-9845
Phone (402) 207-1132

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.6 of 100Reported as apm
Quality
82.13
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Brodstone Memorial Hospital Family Medicine Current Accepting new patients
Brodstone Memorial Hospital Current Accepting new patients
Brodstone Memorial Hospital Family Medicine CurrentSince Jul 1, 2003 Accepting new patients
Brodstone Memorial Hospital CurrentSince Jul 1, 2003 Accepting new patients
The Evangelical Lutheran Good Samaritan Society Past Accepting new patients
Promptcare LLC Family Medicine PastSince Dec 15, 2015 Accepting new patients

Locations

520 E 10th St
Superior, NE 68978
Phone (402) 224-3344

525 E 11th St
Superior, NE 68978
Phone (402) 879-4781

Organizations & group practices 6

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.

Hospital & facility affiliations 9

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": "1135555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599609600000",
    "number": "1295712842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 407",
            "city": "SUPERIOR",
            "state": "NE",
            "postal_code": "689780407",
            "telephone_number": "402-879-4781",
            "fax_number": "402-879-3365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 E 11TH ST",
            "city": "SUPERIOR",
            "state": "NE",
            "postal_code": "689781101",
            "telephone_number": "402-879-4781",
            "fax_number": "402-879-3365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEIS",
        "first_name": "JULIE",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-26",
        "last_updated": "2020-09-09",
        "certification_date": "2020-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "21928",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47038801213",
            "state": "NE"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "JulieTheis@bmh.securechart.com",
            "affiliation": "N",
            "endpointDescription": "direct messaging email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "none",
            "address_1": "525 E 11th St",
            "city": "Superior",
            "state": "NE",
            "country_code": "US",
            "postal_code": "689781101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Superior, NE

Sources for this page

Verify at the official NPI Registry.