Wayne L Anderson, MD
Individual provider Active NPI Surgery Physician · Williston, ND
NPI 1053417840 · NPPES record last updated Oct 24, 2012
Key facts
- NPI
- 1053417840
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- 4768 (ND)
- Practice address
- 1213 15TH Ave W
Suite 200
Williston, ND 58801 - Phone
- (701) 572-4003
- Fax
- (701) 572-4007
- NPI assigned
- Sep 16, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- General Surgery
- Education
- University of North Dakota School of Medicine, 1980
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mercy Medical Center
Practice addresses (Care Compare)
1500 14TH St W
Suite 300
Williston, ND 58801-4079
Phone (701) 774-7500
Hospital & facility affiliations
- CHI St Alexius Health Williston
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Upper gastrointestinal (GI) endoscopy for acid reflux | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
- 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 |
|---|---|---|---|---|
| I20051031000502 | ND | Practitioner - General Surgery | 0345267167 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Home Care | Current |
Accepting new patients | |
| Mercy Medical Center | Current | Accepting new patients | |
| Mercy Medical Center | Current |
Accepting new patients | |
| Mercy Medical Center | Current |
Accepting new patients | |
| John B Andelin MD PC | Current | Accepting new patients | |
| Frances Mahon Deaconess Hospital | Past | Accepting new patients |
Locations
1500 14th St W
Ste 300
Williston, ND 58801
Phone (701) 774-7500
1301 15th Ave W
Williston, ND 58801
Phone (701) 774-7400
1213 15th Ave W
Williston, ND 58801
Phone (701) 572-7641
1213 15th Ave W
Ste 200
Williston, ND 58801
Phone (701) 572-4003
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 4768 | ND | Yes |
Addresses
Primary practice location
1213 15TH Ave W
Suite 200
Williston, ND 58801
Mailing address
1213 15TH Ave W
Suite 200
Williston, ND 58801
Phone (701) 572-4003
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20537 | Other | ND | BLUE CROSS |
| 0040157 | Medicaid | MT | |
| 17987 | Medicaid | ND |
Other providers in Williston, ND
- Derek Anderson
- Gregory A. Anderson
- Jenna Anderson
- Sarah Elizabeth Anderson
- Sheila O Anderson
- Zachary S. Anderson
- Teresa Anfinson
- Marilyn H Archer
- Arie Bauer DDS, PC
- Crystal Lynn Arnson
All providers in Williston, ND · Surgery Physician in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 24, 2012. 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.