Heather Jo Wichman, M.D.
Individual provider Active NPI Vascular & Interventional Radiology Physician · La Crosse, WI
NPI 1043471972 · NPPES record last updated Jan 26, 2015
Key facts
- NPI
- 1043471972
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Vascular & Interventional Radiology Physician 2085R0204X
- License
- 5751820 (WI)
- Practice address
- 1900 South Ave
La Crosse, WI 54601-5467 - Phone
- (608) 775-6569
- NPI assigned
- Jun 23, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 53
Hospital & facility affiliations 13
Medicare Care Compare profile
- Specialty
- Interventional Radiology
- Education
- Medical College of Wisconsin, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Gundersen Lutheran Medical Center Inc
Saint Elizabeths Hospital of Wabasha Inc
Tri-County Memorial Hospital Inc
Moundview Memorial Hospital and Clinics, Inc.
Practice addresses (Care Compare)
1122 W Hwy 61
Winona, MN 55987-1957
Phone (507) 615-0600
1200 Grant Blvd W
Wabasha, MN 55981-1042
Phone (651) 565-4531
1836 S Ave
La Crosse, WI 54601-5429
Phone (608) 783-7300
18601 Lincoln St
Whitehall, WI 54773-8605
Phone (715) 538-4361
1910 S Ave
La Crosse, WI 54601-5467
Phone (608) 782-7300
2575 S 7TH St
Bethany Riverside
La Crosse, WI 54601-5429
Phone (608) 775-8200
402 W Lake St
Friendship, WI 53934-9699
Phone (608) 339-3331
710 Denton St
La Crosse, WI 54601-5447
Phone (608) 782-7300
724 Denton St
La Crosse, WI 54601-5447
Phone (608) 782-7300
Hospital & facility affiliations
- Gundersen Lutheran Medical Center
- St Elizabeth Medical Center
- Veterans Memorial Hospital
- Gundersen Tri-County Hospital & Clinics
- Gundersen Boscobel Area Hospital and Clinics
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in WI, IA, MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120821000401 | WI | Practitioner - Diagnostic Radiology |
7618124090 | Reassigns benefits to 13 organizations |
| I20120914000747 | IA | Practitioner - Diagnostic Radiology | 7618124090 | Reassigns benefits to 4 organizations |
| I20150127002146 | MN | Practitioner - Interventional Radiology |
7618124090 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD40484 | IA | MD | Diagnostic Radiology Physician |
| PY58702 | MN | MD | Diagnostic Radiology Physician |
| 5751820 | WI | MD | Diagnostic Radiology Physician |
Practice roles
Locations
235 8th Ave W
Cresco, IA 52136
Phone (319) 547-2101
1830 State Highway 9
Decorah, IA 52101
Phone (563) 382-2639
40 1st St SE
Waukon, IA 52172
Phone (563) 568-3411
112 Jefferson St
West Union, IA 52175
Phone (563) 422-3811
123 5th Ave SE
Spring Grove, MN 55974
Phone (507) 498-3302
1200 Grant Blvd W
Wabasha, MN 55981
Phone (651) 565-4531
1122 W Highway 61
Winona, MN 55987
Phone (507) 615-0600
711 W Adams St
Blk River Fls, WI 54615
Phone (715) 284-1302
610 W Adams St
Blk River Fls, WI 54615
Phone (715) 284-4311
205 Parker St
Boscobel, WI 53805
Phone (608) 375-4112
1705 Omaha St
Elroy, WI 53929
Phone (608) 462-8270
402 W Lake St
Friendship, WI 53934
Phone (608) 339-3331
1900 South Ave
La Crosse, WI 54601
Phone (608) 775-2287
1910 South Ave
La Crosse, WI 54601
Phone (608) 775-2287
1836 South Ave
La Crosse, WI 54601
Phone (608) 788-8102
1600 Main St
Onalaska, WI 54650
Phone (608) 783-4681
610 E Taylor St
Prairie du Chien, WI 53821
Phone (608) 326-6466
37868 US Highway 18
Prairie du Chien, WI 53821
Phone (608) 357-2000
333 E 2nd St
Richland Ctr, WI 53581
Phone (608) 647-6161
507 S Main St
Viroqua, WI 54665
Phone (608) 637-2101
18601 Lincoln St
Whitehall, WI 54773
Phone (715) 538-1712
Interoperability endpoints
- hwichman82353@direct.emplifyhealth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 5751820 | WI | |
| Diagnostic Radiology Physician | 2085R0202X | MD40484 | IA | |
| Vascular & Interventional Radiology Physician | 2085R0204X | PY58702 | MN | |
| Diagnostic Radiology Physician | 2085R0202X | PY58702 | MN | |
| Vascular & Interventional Radiology Physician | 2085R0204X | MD40484 | IA | |
| Vascular & Interventional Radiology Physician | 2085R0204X | 5751820 | WI | Yes |
Addresses
Primary practice location
1900 South Ave
La Crosse, WI 54601-5467
Mailing address
1900 South Ave
La Crosse, WI 54601-5467
Phone (608) 775-6569
Other providers in La Crosse, WI
- Kimberly A Whitford
- Ryan J Whitford
- Steven W Whitford
- Joshua John Whitson
- Brett S Whyte
- Paula J Wickersham
- Patricia A Wickert
- Garrett J Wickman
- Mark C Wickre
- Erik Wickstrom
All providers in La Crosse, WI · Vascular & Interventional Radiology Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 26, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.