Dale Alan Wickstrum, MD

Primary specialty

Radiation Oncology PhysicianTaxonomy code 2085R0001X

License

ME0035684 Issued in FL

Practice address

2003 Centre Pointe Blvd
Tallahassee, FL 32308-4893

Phone

(850) 878-2273

Fax

(850) 671-5900

NPI assigned

May 22, 2006

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 1

Medicare fee-for-service enrollment

Enrolled in VA

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 Florida College of Medicine, 1976

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Martinsville Physician Practices LLCGroup PAC ID 0143233346, 36 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sovah Health Danville Hospital, Danville, VA, CCN 490075

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/19847/brand/3/csg/21/fhir/r4

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.

• Martinsville Physician Practices LLC

  • Internal Medicine Physician
  • Martinsville, VA
  • NPI 1255380887
  Medicare reassignment Care Compare group NPD
• North Florida Cancer Center Tallahassee LLC

  • Radiation Oncology Physician
  • Tallahassee, FL
  • NPI 1952398448
  NPD
• North Florida Radiation Oncology Associates PA

  • Radiation Oncology Physician
  • Tallahassee, FL
  • NPI 1659349033
  NPD
• Martinsville Physician Practices LLC

  • Rural Health Clinic/Center
  • Martinsville, VA
  • NPI 1558049742
  NPD
• Chattanooga Radiation Oncology Associates PLLC

  • Therapeutic Radiology Physician
  • Ringgold, GA
  • NPI 1891832366
  NPD (past)

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

• Danville Regional Medical Center LLC

  • General Acute Care Hospital
  • Martinsville, VA
  • NPI 1386720183
  Care Compare affiliation
• Danville Regional Medical Center, LLC

  • Rural Acute Care Hospital
  • Danville, VA
  • NPI 1154419737
  Care Compare affiliation

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

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1448236800000",
    "number": "1306890322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14446",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323174446",
            "telephone_number": "850-222-4858",
            "fax_number": "850-431-6591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2003 CENTRE POINTE BLVD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084893",
            "telephone_number": "850-878-2273",
            "fax_number": "850-671-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKSTRUM",
        "first_name": "DALE",
        "middle_name": "ALAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-22",
        "last_updated": "2015-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "FL",
            "license": "ME0035684",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "051677500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Whole Life Primary Care, LLC
• Jahari Whyms
• James Whyte IV, ARNP
• Whitley Jade Whyte, APRN
• Theresa Marie Wicker
• Jessica Widner
• Anzola Wiggins
• Austin Allen Wiggins
• Shonda Lynn Wilber, MSOTR/L, CHT
• Chandra Yvette Wilcox, RPH

• Radiation Oncology Physician in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Radiation Oncology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2015; 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.