Kristen Anne Theobald-Hazel, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

2009001633 Issued in MO

Practice address

1057 Medical Park Dr
Osage Beach, MO 65065-3000

Phone

(573) 302-3100

Fax

(573) 348-8279

NPI assigned

Sep 1, 2006

Sex

Female

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 Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kristentheobaldhazel@mhccaremail.com

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.

• Lake Regional Health System

  • Emergency Medical Services (Emergency Medicine) Physician
  • Osage Beach, MO
  • NPI 1053581454
  Medicare reassignment NPD
• Richland Medical Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Osage Beach, MO
  • NPI 1891931978
  Medicare reassignment NPD
• Lake Regional Health System

  • Durable Medical Equipment & Medical Supplies
  • Lebanon, MO
  • NPI 1578125324
  NPD
• Lake Regional Health System

  • Internal Medicine Physician
  • Osage Beach, MO
  • NPI 1962828616

  Pediatrics

  NPD (past)
• Moberly Hospital Company LLC

  • Rural Health Clinic/Center
  • Salisbury, MO
  • NPI 1851713580
  NPD (past)

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

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630540800000",
    "number": "1932201837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54 HOSPITAL DR",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "650653050",
            "telephone_number": "573-302-3100",
            "fax_number": "573-348-8279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1057 MEDICAL PARK DR",
            "city": "OSAGE BEACH",
            "state": "MO",
            "postal_code": "650653000",
            "telephone_number": "573-302-3100",
            "fax_number": "573-348-8279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEOBALD-HAZEL",
        "first_name": "KRISTEN",
        "middle_name": "ANNE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-01",
        "last_updated": "2021-09-02",
        "certification_date": "2021-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2009001633",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1447229489",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Surgical Institute of Lake of the Ozarks LLC
• Susan Elaine Mitchell
• Lauren Elizabeth Taylor, OTR/L
• Jordan Alaine Teeple, MS, RD, LD
• The Lake'S Liver and Digestive Health Center Inc
• Amy B Thompson, M.D.
• Amy Tillotson, RD, LD
• Stephanie L Tittle, AUD
• Keri Ann Toebben
• Wendy Trimmer, APRN, FNP-C

• Pediatrics Physician in Osage Beach, MO
• Providers in Osage Beach, MO by specialty
• Pediatrics Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2021; 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.