Lee Roy Wiederhold III, MD, PHD

Primary specialty

Radiation Oncology PhysicianTaxonomy code 2085R0001X

License

M5976 Issued in TX

Practice address

301 University Blvd
Galveston, TX 77555-0462

Phone

(409) 772-2531

Fax

(409) 772-1814

NPI assigned

Jun 14, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Radiation Oncology

Education

University of Texas Medical Branch at Galveston, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Physicians Referral ServiceGroup PAC ID 7911801410, 2,728 clinicians

Utmb Faculty Group PracticeGroup PAC ID 3375456734, 1,083 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• University of Texas M D Anderson Cancer Center Hospital, Houston, TX, CCN 450076
• University of Texas Medical Branch Galveston Hospital, Galveston, TX, CCN 450018

Merit-based Incentive Payment System (MIPS)

Final score

78.88 of 100Reported as group

Quality

73.38

Improvement activities

40

Cost

78.42

Merit-based Incentive Payment System (MIPS)

Final score

84.29 of 100Reported as group

Quality

70.82

Promoting interoperability

100

Improvement activities

40

Cost

67.65

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lwiederholdmd10748@direct.utmb.edu

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.

• Physicians Referral Service

  • Multi-Specialty Clinic/Center
  • Houston, TX
  • NPI 1073574810
  Medicare reassignment Care Compare group NPD
• Utmb Faculty Group Practice

  • General Practice Physician
  • Galveston, TX
  • NPI 1942241146
  Medicare reassignment Care Compare group NPD

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

• University of Texas M. D. Anderson Cancer Center

  • General Acute Care Hospital
  • Houston, TX
  • NPI 1174582050
  Care Compare affiliation
• University of Texas Medical Branch at Galveston

  dba University of Texas Medical Branch

  • General Acute Care Hospital
  • Galveston, TX
  • NPI 1548226988
  Care Compare affiliation

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

{
    "created_epoch": "1181779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548720000000",
    "number": "1134323736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 UNIVERSITY BLVD",
            "city": "GALVESTON",
            "state": "TX",
            "postal_code": "775555302",
            "telephone_number": "409-772-2222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 UNIVERSITY BLVD",
            "city": "GALVESTON",
            "state": "TX",
            "postal_code": "775550462",
            "telephone_number": "409-772-2531",
            "fax_number": "409-772-1814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIEDERHOLD",
        "first_name": "LEE",
        "middle_name": "ROY",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-14",
        "last_updated": "2019-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "TX",
            "license": "M5976",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "213444702",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MYUTMB 3847415682-COMMERCIAL NUMBER",
            "identifier": "3847415682",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID CSHCN",
            "identifier": "213444703",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taylor K White, LCDC
• William Eiji Whitehead, MD
• Helen Dannielle Whitehouse, LCSW
• Gay L Whittaker, RN
• Thomas Cullen Wieck, MD
• Jana L Wieser, R.D.
• Cindy L Wigg, MD
• Dana Wild, PT
• Maureen Ann Wilder, ANP
• Constance Elaine Wildey, LCSW

• Radiation Oncology Physician in Galveston, TX
• Providers in Galveston, TX by specialty
• Radiation Oncology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.