Theodore B Jefferson, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

36-112824 Issued in IL

Practice address

11043 Quail Dr
Mokena, IL 60448-8286

Phone

(708) 303-2789

Fax

(708) 300-4772

NPI assigned

Jul 8, 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 2

Medicare fee-for-service enrollment

Enrolled in IL2 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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tjefferson1060741@direct.unitypoint.org

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.

• Integritas Emergency Physician Services, LLC

  • Emergency Medicine Physician
  • Carbondale, IL
  • NPI 1790128817
  Medicare reassignment NPD
• Statera Health Care, LLC

  • Emergency Medicine Physician
  • Harrisburg, IL
  • NPI 1043874449
  Medicare reassignment NPD
• Crawford Hospital District

  • Urology Physician
  • Newton, IL
  • NPI 1265309405
  NPD
• Crawford Hospital District

  • Critical Access Hospital
  • Robinson, IL
  • NPI 1265493720
  NPD
• Crawford Hospital District

  • Internal Medicine Physician
  • Robinson, IL
  • NPI 1861423287

  Family Medicine

  NPD
• Memorial Hospital Association

  • Rural Health Clinic/Center
  • Carthage, IL
  • NPI 1205887742
  NPD
• Memorial Hospital Association

  • Rural Health Clinic/Center
  • Hamilton, IL
  • NPI 1679327779
  NPD
• Memorial Hospital Association

  • Critical Access Hospital
  • Carthage, IL
  • NPI 1730139031
  NPD
• Pana Community Hospital Association

  • Critical Access Hospital
  • Pana, IL
  • NPI 1942326970
  NPD
• St Luke'S Methodist Hospital

  • General Acute Care Hospital
  • Cedar Rapids, IA
  • NPI 1083708226
  NPD
• Countryview Medical Center SC

  • Chiropractor
  • Countryside, IL
  • NPI 1285695544
  NPD (past)
• Palos Community Hospital

  • Psychiatric Hospital Unit
  • Palos Heights, IL
  • NPI 1184699118
  NPD (past)

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1568495091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11043 QUAIL DR",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604488286",
            "telephone_number": "708-303-2789",
            "fax_number": "708-300-4772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11043 QUAIL DR",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604488286",
            "telephone_number": "708-303-2789",
            "fax_number": "708-300-4772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEFFERSON",
        "first_name": "THEODORE",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-08",
        "last_updated": "2023-03-07",
        "certification_date": "2022-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "36-112824",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036112824",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PIN",
            "identifier": "K17486",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leah James
• Vicky James, MA, BCBA
• Jacob Janik, PMHNP
• Jaimie Janik, FNP
• Paulette J Jarke
• JG Eyecare,LTD
• Jill a. Patterson, MD SC
• Jill a. Patterson, MD, S.C.
• Sara Anne Johns, P.T.
• Anastasia Marie Johnson, PHARMD

• Family Medicine Physician in Mokena, IL
• Providers in Mokena, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.