Individual provider Active NPI

Richard Henry Wikiera, D.O.

  • Surgery Physician
  • Maryville, IL
National Provider Identifier
1093962896
Registry record updated Mar 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
36133309 Issued in IL
Practice address
6810 State Route 162 Ste 100
Maryville, IL 62062-8560
Phone
(618) 288-3616
Fax
(618) 288-3647
NPI assigned
Aug 22, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 9, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208600000X 36133309 IL Primary

Addresses

Primary practice location

6810 State Route 162 Ste 100
Maryville, IL 62062-8560

Mailing address

6810 State Route 162 Ste 100
Maryville, IL 62062-8560
Phone (618) 288-3616

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130805000139 IL Practitioner - General Surgery 2163664194 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Kansas City University of Physicians and Surgeons, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anderson Medical Group LLCGroup PAC ID 5193792018, 136 clinicians

Practice addresses (Care Compare)

402 N Wood St
Staunton, IL 62088-1439
Phone (618) 391-6495

6800 State Route 162
Maryville, IL 62062-8500
Phone 6182885711402

6810 State Route 162
Maryville, IL 62062-8501
Phone (618) 288-5711

6812 State Route 162
Maryville, IL 62062-8553

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
74.76 of 100Reported as group
Quality
54.98
Promoting interoperability
85
Improvement activities
40
Cost
73.39

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy33
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Melanoma (skin cancer) excision1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
36133309ILMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Anderson Medical Group, LLC Single Specialty CurrentSince Aug 1, 2013 Accepting new patients

Locations

6810 State Route 162
Ste 215
Maryville, IL 62062
Phone (618) 391-6405

6810 State Route 162
Ste 100
Maryville, IL 62062
Phone (618) 288-3616

6812 State Route 162
Ste 121
Maryville, IL 62062
Phone (314) 543-5999

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583712000000",
    "number": "1093962896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6810 STATE ROUTE 162 STE 100",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620628560",
            "telephone_number": "618-288-3616",
            "fax_number": "618-288-3647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6810 STATE ROUTE 162 STE 100",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620628560",
            "telephone_number": "618-288-3616",
            "fax_number": "618-288-3647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIKIERA",
        "first_name": "RICHARD",
        "middle_name": "HENRY",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-22",
        "last_updated": "2020-03-09",
        "certification_date": "2020-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "IL",
            "license": "36133309",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maryville, IL

Sources for this page

Verify at the official NPI Registry.