Othon Wiltz, M.D.

Primary specialty

Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X

License

0101240155 Issued in VA

Practice address

3620 Joseph Siewick Dr Ste 406
Fairfax, VA 22033-1761

Phone

(703) 359-8640

Fax

(703) 591-6105

NPI assigned

Aug 11, 2005

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

Other identifiers 8

Medicare fee-for-service enrollment

Enrolled in NY

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

Colorectal Surgery (Proctology)Also: General Surgery

Education

Columbia University College of Physicians and Surgeons, 1985

Medicare assignment

May accept Medicare assignment

Group practices

Montefiore Medical CenterGroup PAC ID 3779496021, 2,809 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Montefiore Medical Center Hospital, Bronx, NY, CCN 330059
• Montefiore Mount Vernon Hospital Hospital, Mount Vernon, NY, CCN 330086

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H9678

Interoperability endpoints

• Direct secure messaging: owiltz@montefioredirect.com

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.

• Montefiore Medical Center

  • Anesthesiology Physician
  • Bronx, NY
  • NPI 1063525152
  Medicare reassignment Care Compare group NPD
• Montefiore Medical Center

  • Community/Retail Pharmacy
  • Bronx, NY
  • NPI 1194183715
  NPD
• Gastro Health LLC

  • Gastroenterology Physician
  • Miami, FL
  • NPI 1487767133

  Colon & Rectal Surgery

  NPD (past)
• Gastro Health, LLC

  • Gastroenterology Physician
  • Pembroke Pines, FL
  • NPI 1457026932
  NPD (past)
• Montefiore Medical Center

  • General Acute Care Hospital
  • Bronx, NY
  • NPI 1952476988
  NPD (past)
• Montefiore Mount Vernon Hospital

  • General Acute Care Hospital
  • Mount Vernon, NY
  • NPI 1013345065
  NPD (past)
• MVC PA PLLC

  • Surgery Physician
  • Trevose, PA
  • NPI 1669930798
  NPD (past)

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

• Montefiore Medical Center

  • General Acute Care Hospital
  • Bronx, NY
  • NPI 1952476988
  Care Compare affiliation
• Montefiore Mount Vernon Hospital

  • General Acute Care Hospital
  • Mount Vernon, NY
  • NPI 1992131320
  Care Compare affiliation

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1500940800000",
    "number": "1174525869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3620 JOSEPH SIEWICK DR",
            "address_2": "SUITE 406",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "22033",
            "telephone_number": "703-359-8640",
            "fax_number": "703-591-6105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3620 JOSEPH SIEWICK DR STE 406",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220331761",
            "telephone_number": "703-359-8640",
            "fax_number": "703-591-6105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILTZ",
        "first_name": "OTHON",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-11",
        "last_updated": "2017-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "VA",
            "license": "0101240155",
            "primary": true
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "PR",
            "license": "11687",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LA CRUZ AZUL",
            "identifier": "060957",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MMM",
            "identifier": "601049",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALIC",
            "identifier": "SE4019",
            "state": "PR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174525869",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "1400005",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "311678",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IMC",
            "identifier": "7113",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SSS",
            "identifier": "89937",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melodi Lynette Wilson, M.D.
• Paulina G Wilson, M.D.
• Samantha Wilson
• Sherri Wilson, RN
• Tracey Lynette Wilson
• Natalie Lauren Wilver, PHD
• Sjor'Monique La'Quinta Winbush
• Susan Windley, OTA
• Arthur Ackerman Winer, M.D.
• Natasha Winkowitsch

• Colon & Rectal Surgery Physician in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Colon & Rectal Surgery Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2017; 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.