NPIMap

Individual provider Active NPI

Jeffrey Thiebaud, MD

  • Family Medicine Physician
  • Branson, MO
National Provider Identifier
1831727148
Registry record updated Aug 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2023028882 Issued in MO
Practice address
448 State Highway 248 Ste 140
Branson, MO 65616-3725
Phone
(417) 337-9808
NPI assigned
Mar 31, 2020
Last updated
Aug 10, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Family Medicine Physician 207Q00000X 2023028882 MO Primary

Addresses

Primary practice location

448 State Highway 248 Ste 140
Branson, MO 65616-3725

Mailing address

448 State Highway 248 Ste 140
Branson, MO 65616-3725

Other practice location 1

3401 North Blvd Ste 200
Baton Rouge, LA 70806-3743
Phone (225) 381-6620

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20230804003379 MO Practitioner - Family Practice 8921424722 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Healing Arts Center L.L.C.Group PAC ID 4789620261, 66 clinicians
Mercy Clinic Springfield CommunitiesGroup PAC ID 7416865845, shared by 26 NPIs, 1,121 clinicians

Practice addresses (Care Compare)

225 Violyn Dr
Branson, MO 65616-8128
Phone 4173346660402

3231 S National Ave
Springfield, MO 65807-7304
Phone (417) 888-6735

448 State Hwy 248
Suite 140
Branson, MO 65616-3725
Phone (417) 337-9808

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2023028882MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Springfield Communities Family Medicine CurrentSince Jul 31, 2023 Accepting new patients
Mercy Clinic Springfield Communities Family Medicine CurrentSince Jul 31, 2023 Accepting new patients
Mercy Clinic Springfield Communities Family Medicine CurrentSince Jul 31, 2023 Accepting new patients

Locations

448 State Highway 248
Ste 140
Branson, MO 65616
Phone (417) 337-9808

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

1605 Martin Springs Dr
Ste 330
Rolla, MO 65401
Phone (573) 458-6379

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

3231 S National Ave
Ste 130
Springfield, MO 65807
Phone (417) 841-0280

Organizations & group practices 4

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 10

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": "1585612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691625600000",
    "number": "1831727148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "448 STATE HIGHWAY 248 STE 140",
            "city": "BRANSON",
            "state": "MO",
            "postal_code": "656163725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "448 STATE HIGHWAY 248 STE 140",
            "city": "BRANSON",
            "state": "MO",
            "postal_code": "656163725",
            "telephone_number": "417-337-9808"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3401 North Blvd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Baton Rouge",
            "state": "LA",
            "postal_code": "708063743",
            "country_code": "US",
            "telephone_number": "225-381-6620",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THIEBAUD",
        "first_name": "JEFFREY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-31",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2023028882",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Branson, MO

Sources for this page

Verify at the official NPI Registry.