Stephen E. Thierauf, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036109602 Issued in IL

Practice address

1203 Smizer Mill Rd
Ste 108
Fenton, MO 63026-3483

Phone

(636) 717-1340

Fax

(636) 717-1344

NPI assigned

Dec 28, 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 MO

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

State licenses

Interoperability endpoints

• Direct secure messaging: sthierauf303@directc.mercy.net

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204502400000",
    "number": "1629134333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1203 SMIZER MILL RD",
            "address_2": "STE 108",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630263483",
            "telephone_number": "636-717-1340",
            "fax_number": "636-717-1344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 SMIZER MILL RD",
            "address_2": "STE 108",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630263483",
            "telephone_number": "636-717-1340",
            "fax_number": "636-717-1344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIERAUF",
        "first_name": "STEPHEN",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-28",
        "last_updated": "2008-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036109602",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "204935407",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatrics Physician in Fenton, MO
• Providers in Fenton, MO by specialty
• Pediatrics Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2008; 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.