DR. DAVID A THEODORO (NPI# 1073518577) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073518577 |
| Entity Type | Individual |
| Full Name | DR. DAVID A THEODORO |
| Credential | M.D. |
| Practice Address |
12255 De Paul Dr North Bldg Ste 260 Bridgeton MO 63044 |
| Mailing Address |
Po Box 23666 Jackson MS 39225-3666 |
| Practice Telephone | 3146478269 |
| Practice Fax Number | 3146461700 |
| Mailing Telephone | 6012002780 |
| Mailing Fax Number | 6012002788 |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2020-08-27 |
| NPI Deactivation Date | 03/20/2006 |
| NPI Reactivation Date | 2006-04-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 118293 | MO | Allopathic & Osteopathic Physicians |
| Y | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 28104 | MS | Allopathic & Osteopathic Physicians |
| N | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 036095641 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | SUBSTANCE CONTROL | 036056372 | 01 |
| MO | BNDD | 1102596 | 01 |
| MO | LICENSE | 118293 | 01 |
| IL | LICENSE | 036056372 | 01 |
| IL | 036095641 | 05 | |
| MO | 0360957641 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 970 Lakeland Dr Ste 61, Jackson, MS 392164634 | 6012002780 | 6012002788 |
| Street Address |
12255 DE PAUL DR NORTH BLDG STE 260 |
| City | BRIDGETON |
| State | MO |
| Zip Code | 63044 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073150017 | Zoe Marie Wadsworth | Nurse Practitioner | 12255 Depaul Dr Suite 300, Bridgeton, MO 63044 | 2019-12-10 |
| 1609412451 | Beyond Better, Best Home Health Care Services, Limited Liability Corpo | In Home Supportive Care | 3430 Mckelvey Road Ste B, Bridgeton, MO 63044 | 2019-11-26 |
| 1275189078 | Delicate Angels Home Health LLC | Home Health | 11726 St. Charles Rock Road Suite G, Bridgeton, MO 63044 | 2019-08-16 |
| 1588210082 | Nicholas Huber | Physical Therapist | 12349 Depaul Dr., Ste. 110, Bridgeton, MO 63044 | 2019-08-12 |
| 1124688858 | Michelle Bassett | Registered Nurse | 11520 St. Charles Rock Rd., Suite 106, Bridgeton, MO 63044 | 2019-06-14 |
| 1336703883 | Elena A Barrow | Nurse Practitioner | 12255 Depaul Dr, Suite 260, Bridgeton, MO 63044 | 2019-04-30 |
| 1487123105 | Laura N Steiner | Registered Nurse | Gateway Pediatrics, Ltd, 12255 Depaul Drive, Suite 460 North Medical Building, Bridgeton, MO 63044 | 2018-11-26 |
| 1205310950 | Danielle Mathis | Nurse Practitioner | 3440 Depaul Lane Suite 201, Bridgeton, MO 63044 | 2018-09-19 |
| 1588163570 | Thoughts Out Loud Counseling, LLC | Social Worker | 11520 St. Charles Rock Road Suite 101, Bridgeton, MO 63044 | 2018-02-06 |
| 1912411430 | Breanna Victoria Hayes | Counselor | 3165 Mckevley Road, Suite 200, Bridgeton, MO 63044 | 2017-11-20 |
| Find all providers in zip 63044 | ||||
| Taxonomy Code | 208G00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
| A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Thoracic Surgery, 2007. http://www.abts.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Thoracic Surgery. Thoracic surgeons have the knowledge, experience and technical skills to accurately diagnose, operate upon safely, and effectively manage patients with thoracic diseases of the chest. This requires substantial knowledge of cardiorespiratory physiology and oncology, as well as capability in the use of heart assist devices, management of abnormal heart rhythms and drainage of the chest cavity, respiratory support systems, endoscopy and invasive and noninvasive diagnostic techniques. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952574469 | Ssm Cardiovascular and Thoracic Services, Inc. | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 12255 De Paul Dr, Suite 445, Bridgeton, MO 63044-2510 | 2008-04-04 |
| 1760483101 | Peter Fonseca | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 12266 De Paul Dr Ste 205, Bridgeton, MO 63044-2514 | 2005-08-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891034484 | John Phillip Connors | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1733 Kenmont Rd, Saint Louis, MO 63124-1021 | 2013-02-03 |
| 1699074336 | Joseph John Platz | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1035 Belleville Aveune, Suite 500, St. Louis, MO 63117 | 2011-03-21 |
| 1114243995 | Graham Robertson Young Pollock | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 4320 Wornall Rd Ste 50-ii, Kansas City, MO 64111-5941 | 2010-04-19 |
| 1639305055 | George C Kaiser | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 30 Joy Ave, Webster Groves, MO 63119-2502 | 2009-06-01 |
| 1043460710 | Justin Van Meeteren | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2330 E Meyer Blvd Ste 505, Kansas City, MO 64132-1152 | 2008-09-30 |
| 1508024753 | Tracy Elmer Strevey Jr. | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1509 Woodgate Dr, Frontenac, MO 63131-4724 | 2008-05-23 |
| 1275712010 | Donovan Mitchell Stinnett | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1701 W 26th St, Suite B, Joplin, MO 64804-1513 | 2007-10-29 |
| 1720277197 | Heart and Vascular Care | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 412 Highway 71, Suite J, Pineville, MO 64856-9310 | 2007-10-22 |
| 1801008396 | Peter Fonseca Md, PC | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 10004 Kennerly, Suite 345a, St. Louis, MO 63128 | 2007-05-04 |
| 1669531182 | James N. Pinckley | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1900 S. National, Suite 3400, Springfield, MO 65804 | 2006-12-08 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.