Jeremy Theisen, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

29296 Issued in OK

Practice address

1900 N 14TH St
Ponca City, OK 74601-2035

Phone

(580) 765-0575

NPI assigned

May 29, 2012

Last updated

Sep 23, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in OK, HI, CA, NV, AR, TX, NJ, MS, PA, IL10 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 10

Specialty

Diagnostic Radiology

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Capital Health Multispecialty GroupGroup PAC ID 1850689894, 342 clinicians

Arkansas Health GroupGroup PAC ID 7911802079, 645 clinicians

Alleviate Pain SpecialistsGroup PAC ID 2860837267, 4 clinicians

West Valley Radiology Medical Group IncGroup PAC ID 1658266622, 42 clinicians

Lompoc Valley Medical CenterGroup PAC ID 9739275595, 90 clinicians

Inspira Health Network Medical Group PCGroup PAC ID 4880797570, 238 clinicians

Washington Radiologists Medical Group IncGroup PAC ID 6305927245, 66 clinicians

St Jude Radiology Medical Group IncGroup PAC ID 7214838002, 61 clinicians

Insight Chicago IncGroup PAC ID 2860894706, 140 clinicians

Stillwater Medical Center AuthorityGroup PAC ID 2365353794, 155 clinicians

Stillwater Radiology LLCGroup PAC ID 1153348578, 2 clinicians

Renaissance Medical FoundationGroup PAC ID 1153409867, 178 clinicians

Universal Radiology Partners of NevadaGroup PAC ID 5799295259, 71 clinicians

Modesto Radiological Medical Group IncGroup PAC ID 2062300239, 95 clinicians

San Antonio Radiological MedicalGroup PAC ID 8325035942, 54 clinicians

Oklahoma Radiology Group P CGroup PAC ID 9032101688, 59 clinicians

NRHS Radiology AssociatesGroup PAC ID 2668555731, 61 clinicians

Temple Faculty Practice Plan IncGroup PAC ID 0345588711, 1,325 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Stillwater Medical Center Hospital, Stillwater, OK, CCN 370049
• Stillwater Medical-Blackwell Hospital, Blackwell, OK, CCN 370780
• Stillwater Medical - Perry Hospital, Perry, OK, CCN 370779
• Integris Health Ponca City Hospital, Ponca City, OK, CCN 370006
• O U Medical Center Hospital, Oklahoma City, OK, CCN 370093

Merit-based Incentive Payment System (MIPS)

Final score

91.96 of 100Reported as group

Quality

93.25

Improvement activities

40

Cost

79.74

Merit-based Incentive Payment System (MIPS)

Final score

90.91 of 100Reported as apm

Quality

76.55

Promoting interoperability

100

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

98.1 of 100Reported as group

Quality

86

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

89.78 of 100Reported as group

Quality

80

Improvement activities

40

Cost

75.29

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

100

Improvement activities

40

Cost

84.14

Merit-based Incentive Payment System (MIPS)

Final score

90.41 of 100Reported as group

Quality

88.72

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

53.98 of 100Reported as group

Quality

11.8

Promoting interoperability

74

Improvement activities

0

Cost

82.7

Merit-based Incentive Payment System (MIPS)

Final score

79.56 of 100Reported as group

Quality

76.8

Improvement activities

40

Cost

74.38

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

100

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

98.21 of 100Reported as group

Quality

92.22

Improvement activities

40

Cost

74.96

Merit-based Incentive Payment System (MIPS)

Final score

80.79 of 100Reported as group

Quality

75.74

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles (60 of 69)

Locations (25 of 87)

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: jeremy.theisen.2@30573.direct.athenahealth.com
• Direct secure messaging: jeremy.theisen.p1@direct.wcchc.nextgenshare.com
• Direct secure messaging: jtheisen151507@direct.whhs.com
• Direct secure messaging: jtheisen654499@hisp.ehr.sutterhealth.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.

• Alleviate Pain Specialists

  • Pain Clinic/Center
  • Ponca City, OK
  • NPI 1932971439
  Medicare reassignment Care Compare group NPD
• NRHS Radiology Associates

  • Diagnostic Radiology Physician
  • Norman, OK
  • NPI 1134316169
  Medicare reassignment Care Compare group NPD
• Oklahoma Radiology Group P C

  • Diagnostic Radiology Physician
  • Oklahoma City, OK
  • NPI 1841283165
  Medicare reassignment Care Compare group NPD
• Stillwater Medical Center Authority

  • Family Medicine Physician
  • Stillwater, OK
  • NPI 1558377135

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Stillwater Radiology LLC

  • Diagnostic Radiology Physician
  • Stillwater, OK
  • NPI 1609911452
  Medicare reassignment Care Compare group NPD
• Arkansas Health Group

  dba Baptist Health Radiology Physicians

  • Diagnostic Radiology Physician
  • Little Rock, AR
  • NPI 1861216327
  Medicare reassignment Care Compare group NPD
• Capital Health Multispecialty Group

  • Surgery Physician
  • Trenton, NJ
  • NPI 1083072342

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Insight Chicago, Inc.

  dba Insight Hospital & Medical Center Chicago

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1881261006
  Medicare reassignment Care Compare group NPD
• Inspira Health Network Medical Group, P.C.

  dba Inspira Medical Group

  • Multi-Specialty Clinic/Center
  • Glassboro, NJ
  • NPI 1922177856
  Medicare reassignment Care Compare group NPD
• Lompoc Valley Medical Center

  • General Practice Physician
  • Lompoc, CA
  • NPI 1649282856

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Renaissance Medical Foundation

  • Internal Medicine Physician
  • Edinburg, TX
  • NPI 1467633867

  OK

  Medicare reassignment Care Compare group NPD
• San Antonio Radiological Medical

  • Diagnostic Radiology Physician
  • Upland, CA
  • NPI 1457396947

  OK

  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Integris Health Ponca City Hospital Inc

  dba Integris Health Ponca City Hospital

  • General Acute Care Hospital
  • Ponca City, OK
  • NPI 1548047616
  Care Compare affiliation
• Ou Medicine Inc.

  • General Acute Care Hospital
  • Oklahoma City, OK
  • NPI 1649794157
  Care Compare affiliation
• Stillwater Medical Center Authority

  dba Perry Memorial Hospital

  • Rural Acute Care Hospital
  • Perry, OK
  • NPI 1003318692
  Care Compare affiliation
• Stillwater Medical Center Authority

  dba Blackwell Regional Hospital

  • Rural Acute Care Hospital
  • Blackwell, OK
  • NPI 1104375237
  Care Compare affiliation
• Stillwater Medical Center Authority

  dba Stillwater Medical Center

  • General Acute Care Hospital
  • Stillwater, OK
  • NPI 1164494027
  Care Compare affiliation

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

{
    "created_epoch": "1338249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758585600000",
    "number": "1881954501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 N 14TH ST",
            "city": "PONCA CITY",
            "state": "OK",
            "postal_code": "746012035",
            "telephone_number": "580-765-0575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 N 14TH ST",
            "city": "PONCA CITY",
            "state": "OK",
            "postal_code": "746012035",
            "telephone_number": "580-765-0575"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "920 Sl Young Blvd",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731045036",
            "country_code": "US",
            "telephone_number": "405-271-5963",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "920 Sl Young Blvd",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731045036",
            "country_code": "US",
            "telephone_number": "405-271-5963",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "750 Brunswick Ave",
            "address_purpose": "LOCATION",
            "city": "Trenton",
            "state": "NJ",
            "postal_code": "086384143",
            "country_code": "US",
            "telephone_number": "609-394-6000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Capital Way",
            "address_purpose": "LOCATION",
            "city": "Pennington",
            "state": "NJ",
            "postal_code": "085342520",
            "country_code": "US",
            "telephone_number": "609-303-4000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "310 Salem Woodstown Rd",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "NJ",
            "postal_code": "080792064",
            "country_code": "US",
            "telephone_number": "856-339-6054",
            "fax_number": "856-935-6714",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THEISEN",
        "first_name": "JEREMY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-29",
        "last_updated": "2025-09-23",
        "certification_date": "2025-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "29296",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "HI",
            "license": "MD-23144",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OK",
            "license": "29296",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NJ",
            "license": "25IA12501900",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Talk to Me Speech Therapy Services (Central Therapy)
• Jackie Sue Tarr, LPN
• Tem Projects LLC (Proving Faithful)
• Ronald Albert Terry, DPH
• The Hamilton Clinic, Inc.
• Thomas M Carter MD, Inc.
• Catherine R Thomas, R.N.
• Chase Scott Thomas
• Linda Yvonne Thomas
• Rachel C Thomas, HIS

• Diagnostic Radiology Physician in Ponca City, OK
• Providers in Ponca City, OK by specialty
• Diagnostic Radiology Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.