Tyler Wishau

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

016005806 Issued in IL

Practice address

2 Good Samaritan Way Ste 420
Mount Vernon, IL 62864-2478

Phone

(618) 899-3900

NPI assigned

Apr 9, 2014

Last updated

Sep 29, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in VA, IL2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Podiatry

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Physician Services Corporation of Southern Illinois IncGroup PAC ID 9234022567, 120 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Good Samaritan Regional HLTH Center Hospital, Mount Vernon, IL, CCN 140046
• SSM Health St Mary's Hospital -Centralia Hospital, Centralia, IL, CCN 140034
• Hamilton Memorial Hospital Hospital, McLeansboro, IL, CCN 141326
• Deaconess Illinois Crossroads Hospital, Mount Vernon, IL, CCN 140294
• Franklin Hospital Hospital, Benton, IL, CCN 141321

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: twishau112073@direct-ehr-ssmhc.com

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

• Physician Services Corporation of Southern Illinois Inc.

  dba SSM Health Medical Group

  • Internal Medicine Physician
  • Mount Vernon, IL
  • NPI 1831101807
  Medicare reassignment Care Compare group NPD

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

• Deaconess Illinois Crossroads Inc

  dba Crossroads Community Hospital

  • General Acute Care Hospital
  • Mount Vernon, IL
  • NPI 1124745807
  Care Compare affiliation
• Franklin Hospital District

  • Critical Access Hospital
  • Benton, IL
  • NPI 1699778951
  Care Compare affiliation
• Good Samaritan Regional Health Center

  dba SSM Health Good Samaritan Hospital - Mt. Vernon

  • General Acute Care Hospital
  • Mount Vernon, IL
  • NPI 1609897339
  Care Compare affiliation
• Hamilton Memorial Hospital District

  • Critical Access Hospital
  • McLeansboro, IL
  • NPI 1447257258
  Care Compare affiliation
• Hamilton Memorial Hospital District

  dba Carmi Family Clinic

  • Rural Health Clinic/Center
  • Carmi, IL
  • NPI 1588902183

  Hospital

  Care Compare affiliation
• St Mary's Hospital, Centralia, Illinois

  dba SSM Health St. Mary's Hospital - Centralia

  • General Acute Care Hospital
  • Centralia, IL
  • NPI 1083617245
  Care Compare affiliation

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

{
    "created_epoch": "1397001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790640000000",
    "number": "1144649856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 955860",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631952588",
            "telephone_number": "636-498-5944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 GOOD SAMARITAN WAY STE 420",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642478",
            "telephone_number": "618-899-3900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12303 DePaul Dr.",
            "address_purpose": "LOCATION",
            "city": "Bridgeton",
            "state": "MO",
            "postal_code": "630442588",
            "country_code": "US",
            "telephone_number": "314-344-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WISHAU",
        "first_name": "TYLER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-09",
        "last_updated": "2026-09-29",
        "certification_date": "2022-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IL",
            "license": "016005806",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "016005806",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "twishau112073@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "twishau112073@direct-ehr-ssmhc.com",
            "address_1": "2 Good Samaritan Way Ste 420",
            "city": "Mount Vernon",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628642478",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "2 Good Samaritan Way Ste 420",
            "city": "Mount Vernon",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628642478",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kathleen Winkelmann, BS
• Jade Winne, MHP
• Jenna M Winters, CRNA
• Wise Health Solutions, LTD.
• Robert L Wise, D.C.
• Stacy Withrow, RN
• Womens Health Associates of Southern Illinois, S. C.
• Peter Wong, MD
• Lincoln C Woodrome, DMD
• Roger Blair Woodrome, D.M.D.

• Foot & Ankle Surgery Podiatrist in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• Foot & Ankle Surgery Podiatrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2026; 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.