1. Home
  2. Directory
  3. Missouri
  4. Bridgeton
  5. Thoracic Surgery Cardiothoracic Vascular Surgery
  6. NPI Profile

DR. DAVID A THEODORO M.D.
NPI 1073518577
Thoracic Surgery (Cardiothoracic Vascular Surgery) in Bridgeton, MO

Active since June 20, 2005PECOS EnrolledAccepts Medicare Assignment
12255 DE PAUL DR NORTH BLDG, STE 260, BRIDGETON, MO 63044(314) 647-8269(314) 646-1700 Get Directions Write a Review

NPPES record last updated: August 27, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Dr. David A Theodoro M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. DAVID A THEODORO M.D. (NPI 1073518577) is an individual thoracic surgery (cardiothoracic vascular surgery) provider in Bridgeton, Missouri, licensed in Mississippi (28104) and active in the NPI registry since June 2005. He is enrolled in Medicare PECOS, is affiliated with St Dominic-jackson Memorial Hospital, and maintains a secondary practice location in Jackson.

NPPES Registry Identity

NPI1073518577
Entity TypeIndividualMale
Primary Taxonomy208G00000X
Provider Legal NameDR. DAVID A THEODOROCredential: M.D.
Location Address12255 DE PAUL DR NORTH BLDG, STE 260Bridgeton, MO 63044
Mailing AddressPo Box 23666Jackson, MS 39225-3666 · (601) 200-2780 · Fax (601) 200-2788
Phone(314) 647-8269
Fax(314) 646-1700
Sole ProprietorNo
Medical School CMSWashington University School Of MedicineGraduated 1988
Enumeration DateJune 20, 2005
Last NPPES UpdateAugust 27, 2020
NPPES CertifiedAugust 27, 2020
✔ NPI 1073518577 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyThoracic Surgery (Cardiothoracic Vascular Surgery)Allopathic & Osteopathic Physicians
Taxonomy Code208G00000X
Licenses✔ Licensed in MS · 28104✔ Licensed in IL · 036095641✔ Licensed in MO · 118293
Definition
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.
12255 DE PAUL DR NORTH BLDG, Bridgeton, MO 63044
Open in Google Maps ↗

Secondary Practice Location 1

Location 1970 Lakeland Dr Ste 61Jackson, MS 39216-4634 · Phone (601) 200-2780 · Fax (601) 200-2788

Other Identifiers 6

Other036056372IL · Substance Control
Other1102596MO · Bndd
Other118293MO · License
Other036056372IL · License
Medicaid036095641IL
Medicaid0360957641MO

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Cigna Healthcare, UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. David A Theodoro M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4789578238
PECOS Enrollment IDI20200831002412
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show David Theodoro reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Ssm Medical Group, Inc.
16 mi
Multi-Specialty
1011 BOWLES AVE, SUITE 300
Fenton, MO 63026
  • Reassigned Medicare billing, Missouri enrollment
  • 697 clinicians in this Medicare group
NPI 1700966207 (636) 496-5000
St. Dominic Medical Associates, LLC
434 mi
Dermatology
106 HIGHLAND WAY STE 208
Madison, MS 39110
  • Reassigned Medicare billing, Mississippi enrollment
  • 136 clinicians in this Medicare group
NPI 1326646845 (601) 200-3376

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 6

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
66 services61 patients
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204
This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
63 services63 patients
Coronary artery bypass using artery graft, 1 graft 33533
A coronary artery bypass with one artery graft is a surgical procedure to improve blood flow to your heart. An artery from another part of your body is used to bypass a blocked or narrowed coronary artery. This can help reduce chest pain and risk of heart attack.
34 services34 patients
Harvest of vein using an endoscope 33508
Harvesting a vein using an endoscope is a procedure where a small camera is used to help surgeons remove a vein from your body. This vein is often used to bypass a blocked artery, improving blood flow to your heart.
29 services29 patients
Coronary artery bypass using vein or artery graft, 2 grafts 33518
A coronary artery bypass with 2 grafts is a surgery to improve blood flow to your heart. A surgeon takes a healthy vein or artery from your body and attaches it to the blocked coronary artery. This creates a new path for blood to flow, bypassing the blockage.
19 services19 patients
Replacement of aortic valve on heart-lung machine 33405
The aortic valve replacement on a heart-lung machine is a procedure where your faulty aortic valve is replaced with a new one. During this operation, a machine takes over the job of your heart and lungs, ensuring the blood supply to your body is maintained.
16 services16 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

St Dominic-Jackson Memorial Hospital

Acute Care Hospitals · Jackson, MS
2/5 CMS rating
OwnershipVoluntary non-profit - Church
CMS Certification Number250048
Location969 Lakeland DrJackson, MS 39216 · Hinds County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 63044 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$169.38 typical visit price
range $55.65 – $169.38
Typical copayment $42.34 (range $13.91 – $42.34)
Most-billed visit code 99205
Established Patient
$69.50 typical visit price
range $17.76 – $137.92
Typical copayment $17.37 (range $4.44 – $34.48)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is David Theodoro's NPI number?

The NPI number for David Theodoro is 1073518577. It was assigned to this individual provider in the NPPES registry on June 20, 2005.

Where is David Theodoro located?

David Theodoro practices at 12255 De Paul Dr North Bldg Ste 260, Bridgeton, MO 63044. The listed phone number is (314) 647-8269.

What is David Theodoro's specialty?

The primary specialty registered for this NPI is Thoracic Surgery (Cardiothoracic Vascular Surgery) with taxonomy code 208G00000X.

Is David Theodoro enrolled in Medicare?

Yes. David Theodoro is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for David Theodoro's services?

According to the CMS Revalidation Reassignment List (October 2026 release), David Theodoro reassigns Medicare benefits to 2 organizations: Ssm Medical Group, Inc. (Fenton, MO) and St. Dominic Medical Associates, LLC (Madison, MS). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for David Theodoro's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does David Theodoro accept?

Health plans from Cigna Healthcare and UnitedHealthcare list David Theodoro as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is David Theodoro affiliated with any hospitals?

According to CMS data, David Theodoro is affiliated with St Dominic-Jackson Memorial Hospital.

When was this NPI record last updated?

The NPPES record for David Theodoro was last updated on August 27, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.