DAVID A. THEODORO M.D. – NPI #1073518577
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.

Health Care Provider Taxonomy Code for Thoracic Surgery (Cardiothoracic Vascular Surgery)

DAVID THEODORO is a thoracic surgeon located in BRIDGETON, MO. NPPES has assigned the NPI number 1073518577 to DAVID THEODORO on June 20, 2005. It is a Type-1 NPI, indicating this NPI number is associated with an individual. The primary taxonomy selected by this provider is 208G00000X from the Health Care Provider Taxonomy code set, which is classified as Thoracic Surgery (Cardiothoracic Vascular Surgery).

The NPI profile was previously updated about 6 years ago on Aug 27, 2020. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for DAVID THEODORO below.

NPI Profile for
DAVID A. THEODORO

NPI Number
1073518577
Enumeration Date

(about 21 years ago)
Entity Type
Type-1  Individual (Male)
Legal Name
DAVID A. THEODORO
Credentials
M.D.
Primary location
12255 DE PAUL DR NORTH BLDG
STE 260
BRIDGETON, MO 63044
Phone: (314) 647-8269 Fax: (314) 646-1700
1 Other location(s):
970 Lakeland Dr Ste 61
Jackson, MS 39216-4634
Phone: (601) 200-2780
Fax: (601) 200-2788
Mailing address
PO BOX 23666
JACKSON, MS 39225-3666
Phone: (601) 200-2780 Fax: (601) 200-2788
Sole Proprietor
No
Updated
Certification Date
Aug 27, 2020

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for DAVID THEODORO

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

See identifiers
DescriptionIssuerStateIdentifier
OTHERBNDDMO1102596
OTHERLICENSEIL036056372
OTHERLICENSEMO118293
OTHERSUBSTANCE CONTROLIL036056372
MEDICAIDIL036095641
MEDICAIDMO0360957641
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
208G00000X
- Thoracic Surgery (Cardiothoracic Vascular Surgery) (Primary)		 MO 118293

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.

Additional Information

Education
WASHINGTON UNIVERSITY SCHOOL OF MEDICINE - Graduated 1988
Accepts Medicare
This provider accepts Medicare-approved amount as payment in full. The Medicare-approved amount is the total the provider can be paid. When a provider accepts the Medicare-approved amount as payment, you won't be billed for more than the Medicare deductible & coinsureance.
Medicare Ordering & Referring
Provider can:
  • Refer to Part B
  • Order Durable Medical Equipment
  • Refer to Home Health Agency
  • Order Power Mobility Devices
Affiliations
DAVID THEODORO is affiliated with the following medical group(s):
  • HOSPITAL
    • ST DOMINIC-JACKSON MEMORIAL HOSPITAL
      969 LAKELAND DR
      JACKSON, MS 39216

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