Jeremy Theisen, MD - Medicare Diagnostic Radiology in Ponca City, OK

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Jeremy Theisen, MD is a medicare enrolled "Radiology - Diagnostic Radiology" physician in Ponca City, Oklahoma. He went to University Of Oklahoma College Of Medicine and graduated in 2012 and has 14 years of diverse experience with area of expertise as Diagnostic Radiology. He is a member of the group practice Placerville Radiology Medical Group Inc, Stillwater Radiology Llc, West Valley Radiology Medical Group Inc, Modesto Radiological Medical Group Inc, Nrhs Radiology Associates, Alleviate Pain Specialists, Radx Imaging Partners Inc, Washington Radiologists Medical Group Inc, St Jude Radiology Medical Group Inc, Universal Radiology Partners Of California Pc, Arkansas Health Group and his current practice location is 1900 N 14th St, Ponca City, Oklahoma. You can reach out to his office (for appointments etc.) via phone at (580) 765-0575.

Jeremy Theisen is licensed to practice in Oklahoma (license number 29296) 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 1881954501.

Contact Information

Jeremy Theisen, MD
1900 N 14th St,
Ponca City, OK 74601-2035
(580) 765-0575
Not Available

Map and Direction




Physician's Profile

Full NameJeremy Theisen
GenderMale
SpecialityDiagnostic Radiology
Experience14 Years
Location1900 N 14th St, Ponca City, Oklahoma
Accepts Medicare AssignmentsYes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Jeremy Theisen attended and graduated from University Of Oklahoma College Of Medicine in 2012
  NPI Data:
  • NPI Number: 1881954501
  • Provider Enumeration Date: 05/29/2012
  • Last Update Date: 09/23/2025
  Medicare PECOS Information:
  • PECOS PAC ID: 1355571746
  • Enrollment ID: I20140304001840

Medical Identifiers

Medical identifiers for Jeremy Theisen such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1881954501NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
2085R0202XRadiology - Diagnostic Radiology MD-23144 (Hawaii)Secondary
207R00000XInternal Medicine 29296 (Oklahoma)Secondary
2085R0202XRadiology - Diagnostic Radiology 29296 (Oklahoma)Primary
2085R0202XRadiology - Diagnostic Radiology 25IA12501900 (New Jersey)Secondary

Medical Facilities Affiliation

Facility NameLocationFacility Type
Stillwater Medical CenterStillwater, OKHospital
Ponca City Medical CenterPonca city, OKHospital
Baptist Health Medical Center-little RockLittle rock, ARHospital

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Placerville Radiology Medical Group Inc014338237448
Stillwater Radiology Llc11533485782
West Valley Radiology Medical Group Inc165826662241
Modesto Radiological Medical Group Inc206230023989
Nrhs Radiology Associates266855573158
Alleviate Pain Specialists28608372673
Radx Imaging Partners Inc569811304146
Washington Radiologists Medical Group Inc630592724552
St Jude Radiology Medical Group Inc721483800260
Universal Radiology Partners Of California Pc721437298668
Arkansas Health Group7911802079579

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. Jeremy Theisen allows following entities to bill medicare on his behalf.
Entity NameOklahoma Radiology Group P C
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1841283165
PECOS PAC ID: 9032101688
Enrollment ID: O20040401001538
Entity NameStillwater Radiology Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1609911452
PECOS PAC ID: 1153348578
Enrollment ID: O20051025000959
Entity NameEagle Partners Pllc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1548450976
PECOS PAC ID: 9032205752
Enrollment ID: O20071011000078
Entity NameNrhs Radiology Associates
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1134316169
PECOS PAC ID: 2668555731
Enrollment ID: O20080213000018
Entity NameModesto Radiological Medical Group Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1992747547
PECOS PAC ID: 2062300239
Enrollment ID: O20190116001638
Entity NameLos Robles Radiologic Associates
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1730157215
PECOS PAC ID: 0446319206
Enrollment ID: O20190314000407
Entity NameCentral Valley Imaging Medical Associates Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1275523169
PECOS PAC ID: 8628064953
Enrollment ID: O20190408002347
Entity NameRenaissance Radiology Associates Pllc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1275181455
PECOS PAC ID: 0345571881
Enrollment ID: O20191017000730
Entity NameWest Valley Radiology Medical Group Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1265486427
PECOS PAC ID: 1658266622
Enrollment ID: O20210611000528
Entity NameSilicon Valley Diagnostic Imaging Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1629265806
PECOS PAC ID: 5496838518
Enrollment ID: O20210706002856
Entity NameFocus Medical Imaging
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1528299989
PECOS PAC ID: 6406999259
Enrollment ID: O20220331002161
Entity NameSt Jude Radiology Medical Group Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1649349705
PECOS PAC ID: 7214838002
Enrollment ID: O20220503002319
Entity NamePlacerville Radiology Medical Group Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1700847621
PECOS PAC ID: 0143382374
Enrollment ID: O20230601000827
Entity NameRadiology Consultants Ltd
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1285735571
PECOS PAC ID: 9032195128
Enrollment ID: O20231104000729
Entity NameAlleviate Pain Specialists
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1932971439
PECOS PAC ID: 2860837267
Enrollment ID: O20240226000797
Entity NameWashington Radiologists Medical Group Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1851355622
PECOS PAC ID: 6305927245
Enrollment ID: O20240625000408
Entity NameRenaissance Medical Foundation
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1467633867
PECOS PAC ID: 1153409867
Enrollment ID: O20241007000481
Entity NameFullerton Radiology Medical Group Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1861451858
PECOS PAC ID: 4587632575
Enrollment ID: O20241021003869
Entity NameSan Antonio Radiological Medical
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1457396947
PECOS PAC ID: 8325035942
Enrollment ID: O20241022005385
Entity NameRadx Imaging Partners Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1366146755
PECOS PAC ID: 5698113041
Enrollment ID: O20241101002549
Entity NameDelta Radiology Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1881728327
PECOS PAC ID: 5294795308
Enrollment ID: O20250409001339
Entity NameHampton Roads Radiology Associates Pc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1174533624
PECOS PAC ID: 4880688506
Enrollment ID: O20250429003046

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. Jeremy Theisen 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 AddressPractice Location Address
Jeremy Theisen, MD
1900 N 14th St,
Ponca City, OK 74601-2035

Ph: (580) 765-0575		Jeremy Theisen, MD
1900 N 14th St,
Ponca City, OK 74601-2035

Ph: (580) 765-0575

Reviews and Comments


Radiology Doctors in Ponca City, OK


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Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

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