Dr David A Theodoro, MD is a medicare enrolled "Thoracic Surgery (cardiothoracic Vascular Surgery)" physician in Bridgeton, Missouri. He went to Washington University School Of Medicine and graduated in 1988 and has 36 years of diverse experience with area of expertise as Thoracic Surgery. He is a member of the group practice St. Dominic Medical Associates Llc and his current practice location is
12255 De Paul Dr North Bldg, Ste 260, Bridgeton, Missouri. You can reach out to his office (for appointments etc.) via phone at
(314) 647-8269.
Dr David A Theodoro is licensed to practice in Mississippi (license number 28104) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1073518577.
Physician's Profile
| Full Name | Dr David A Theodoro |
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| Gender | Male |
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| Speciality | Thoracic Surgery |
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| Experience | 36 Years |
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| Location | 12255 De Paul Dr North Bldg, Bridgeton, Missouri |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Dr David A Theodoro attended and graduated from Washington University School Of Medicine in 1988
NPI Data:
- NPI Number: 1073518577
- Provider Enumeration Date: 06/20/2005
- Last Update Date: 08/27/2020
Medicare PECOS Information:
- PECOS PAC ID: 4789578238
- Enrollment ID: I20200831002412
Medical Identifiers
Medical identifiers for Dr David A Theodoro such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1073518577 | NPI | - | NPPES |
| 036056372 | Other | IL | SUBSTANCE CONTROL |
| 0360957641 | Medicaid | MO | |
| 1102596 | Other | MO | BNDD |
| 036056372 | Other | IL | LICENSE |
| 118293 | Other | MO | LICENSE |
| 036095641 | Medicaid | IL | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 208G00000X | Thoracic Surgery (cardiothoracic Vascular Surgery) | 118293 (Missouri) | Secondary |
| 208G00000X | Thoracic Surgery (cardiothoracic Vascular Surgery) | 036095641 (Illinois) | Secondary |
| 208G00000X | Thoracic Surgery (cardiothoracic Vascular Surgery) | 28104 (Mississippi) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| St. Dominic Medical Associates Llc | 0446303168 | 156 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr David A Theodoro allows following entities to bill medicare on his behalf.
| Entity Name | St. Dominic Medical Associates Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1407920549
PECOS PAC ID: 0446303168
Enrollment ID: O20090728000821 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr David A Theodoro is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Dr David A Theodoro, MD
Po Box 23666,
Jackson, MS 39225-3666
Ph: (601) 200-2780 | Dr David A Theodoro, MD
12255 De Paul Dr North Bldg, Ste 260,
Bridgeton, MO 63044
Ph: (314) 647-8269 |
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