Maxine A Theriot, MD is a medicare enrolled "Preventive Medicine - Undersea And Hyperbaric Medicine" physician in Poplar Bluff, Missouri. She went to Loma Linda University School Of Medicine and graduated in 1994 and has 30 years of diverse experience with area of expertise as Family Practice. She is a member of the group practice Poplar Bluff Hma Physician Management, Llc and her current practice location is
3098 Oak Grove Rd, Poplar Bluff, Missouri. You can reach out to her office (for appointments etc.) via phone at
(573) 686-8199.
Maxine A Theriot is licensed to practice in Missouri (license number 2022047286) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1194874628.
Physician's Profile
| Full Name | Maxine A Theriot |
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| Gender | Female |
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| Speciality | Family Practice |
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| Experience | 30 Years |
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| Location | 3098 Oak Grove Rd, Poplar Bluff, Missouri |
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| Accepts Medicare Assignments | Yes. She 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:
- Maxine A Theriot attended and graduated from Loma Linda University School Of Medicine in 1994
NPI Data:
- NPI Number: 1194874628
- Provider Enumeration Date: 01/10/2007
- Last Update Date: 07/13/2023
Medicare PECOS Information:
- PECOS PAC ID: 0648296525
- Enrollment ID: I20230322000964
Medical Identifiers
Medical identifiers for Maxine A Theriot such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1194874628 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207Q00000X | Family Medicine | J9578 (Texas) | Secondary |
| 2083P0011X | Preventive Medicine - Undersea And Hyperbaric Medicine | J9578 (Texas) | Secondary |
| 2083P0011X | Preventive Medicine - Undersea And Hyperbaric Medicine | 2022047286 (Missouri) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Poplar Bluff Hma Physician Management, Llc | 5092769703 | 38 |
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. Maxine A Theriot allows following entities to bill medicare on her behalf.
| Entity Name | Poplar Bluff Hma Physician Management, Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1598710147
PECOS PAC ID: 5092769703
Enrollment ID: O20050307000013 |
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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. Maxine A Theriot 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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Maxine A Theriot, MD
709 W Rusk St Ste B,
Rockwall, TX 75087-3600
Ph: (972) 786-0140 | Maxine A Theriot, MD
3098 Oak Grove Rd,
Poplar Bluff, MO 63901-8938
Ph: (573) 686-8199 |
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