NPIMap

Individual provider Active NPI

Paul Wetstein, M.D.

  • Surgery Physician
  • Champaign, IL
National Provider Identifier
1104189166
Registry record updated Mar 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
036166628 Issued in IL
Practice address
3105 Fields South Dr
Champaign, IL 61822-3743
Phone
(217) 383-3240
NPI assigned
Jun 24, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Critical Care Physician 2086S0102X ME135643 FL
Student in an Organized Health Care Education/Training Program 390200000X
Surgery Physician 208600000X 036166628 IL Primary

Addresses

Primary practice location

3105 Fields South Dr
Champaign, IL 61822-3743

Mailing address

3105 Fields South Dr
Champaign, IL 61822-3743
Phone (217) 383-3240

Other practice location 1

1800 NW 10th Ave
Miami, FL 33136-1018
Phone (305) 585-1179

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, ND, IL3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20201029000403 FL Practitioner - General Surgery 7517377724 Reassigns benefits to 1 organization
I20230216002121 ND Practitioner - Internal MedicinePractitioner - Critical Care (Intensivists) 7517377724 Reassigns benefits to 1 organization
I20231221002085 IL Practitioner - General Surgery 7517377724 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Uniformed Services Uhs Fe Hebert School of Med, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of MiamiGroup PAC ID 3274795109, 2,346 clinicians
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Practice addresses (Care Compare)

1800 NW 10TH Ave
Ryder Trauma Center
Miami, FL 33136-1018
Phone (305) 355-5006

611 W Park St
Urbana, IL 61801-2500

611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753

Hospital & facility affiliations

  • Jackson Health System Hospital, Miami, FL, CCN 100022
  • Carle Foundation Hospital Hospital, Urbana, IL, CCN 140091

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036166628ILMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carle Health Care Incorporated CurrentSince Dec 12, 2023 Accepting new patients
Sanford Bismarck CurrentSince Dec 23, 2022 Accepting new patients
Sanford Bismarck CurrentSince Dec 23, 2022 Accepting new patients
University of Miami Current Accepting new patients
University of Miami CurrentSince Jul 31, 2020 Accepting new patients
University of Miami CurrentSince Jul 31, 2020 Accepting new patients
University of Miami Past Accepting new patients

Locations

1800 NW 10th Ave
Miami, FL 33136
Phone (305) 243-3838

1611 NW 12th Ave
Miami, FL 33136
Phone (305) 585-6226

1611 NW 12th Ave
Ste 600B
Miami, FL 33136
Phone (305) 355-1303

3105 Fields South Dr
Champaign, IL 61822
Phone (217) 902-3277

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

3318 N 14th St
Bismarck, ND 58503
Phone (701) 323-8300

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 7

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 25

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

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1340496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709596800000",
    "number": "1104189166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3105 FIELDS SOUTH DR",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618223743",
            "telephone_number": "217-383-3240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3105 FIELDS SOUTH DR",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618223743",
            "telephone_number": "217-383-3240"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1800 NW 10th Ave",
            "address_purpose": "LOCATION",
            "city": "Miami",
            "state": "FL",
            "postal_code": "331361018",
            "country_code": "US",
            "telephone_number": "305-585-1179",
            "fax_number": "305-585-1180",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WETSTEIN",
        "first_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-24",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "FL",
            "license": "ME135643",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036166628",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Champaign, IL

Sources for this page

Verify at the official NPI Registry.