NPIMap

Individual provider Active NPI

Michael J Willerth, MD

  • Surgery Physician
  • Fort Dodge, IA
National Provider Identifier
1316919202
Registry record updated Dec 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
31679 Issued in IA
Practice address
804 Kenyon Rd
Fort Dodge, IA 50501-5742
Phone
(515) 574-6865
NPI assigned
Feb 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 31679 IA Primary

Addresses

Primary practice location

804 Kenyon Rd
Fort Dodge, IA 50501-5742

Mailing address

24 N 9TH St
Suite a
Fort Dodge, IA 50501-3909
Phone (515) 574-6890

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100224000956 IA Practitioner - Vascular SurgeryPractitioner - General Surgery 7618029422 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Vascular SurgeryAlso: General Surgery
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

804 Kenyon Rd
Suite G
Fort Dodge, IA 50501-5742
Phone (515) 573-4141

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion1-10
Varicose vein removal32
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
31679IAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Iowa Specialty Hospital- Clarion CurrentSince Jan 1, 2025 Accepting new patients
Iowa Physicians Clinic Medical Foundation Surgery CurrentSince Jan 1, 2017 Accepting new patients
St Luke'S Methodist Hospital Current Accepting new patients
Belmond Community Hospital CurrentSince Aug 17, 2017 Accepting new patients
Belmond Community Hospital CurrentSince Jan 1, 2026 Accepting new patients
Belmond Community Hospital Past Accepting new patients
Trimark Physicians Group Inc PastSince Jan 29, 2009 Accepting new patients
Trinity Regional Medical Center PastSince Feb 15, 2022 Accepting new patients

Locations

403 1st St SE
Belmond, IA 50421
Phone (641) 444-3223

4480 Utica Ridge Rd
Ste 2230
Bettendorf, IA 52722
Phone (563) 742-5150

4480 Utica Ridge Rd
Ste 160
Bettendorf, IA 52722
Phone (563) 742-5950

215 13th Ave SW
Clarion, IA 50525
Phone (515) 532-2836

1316 S Main St
Clarion, IA 50525
Phone (515) 532-2811

800 Kenyon Rd
Ste S
Fort Dodge, IA 50501
Phone (515) 573-4141

804 Kenyon Rd
Ste G
Fort Dodge, IA 50501
Phone (515) 573-4141

804 Kenyon Rd
Fort Dodge, IA 50501
Phone (515) 574-6870

802 Kenyon Rd
Fort Dodge, IA 50501
Phone (515) 574-6565

1010 15th St N
Humboldt, IA 50548
Phone (515) 332-2015

2015 W 5th St
Storm Lake, IA 50588
Phone (717) 732-6650

Interoperability endpoints

  • Direct secure messaging: mwillerth124591@uihcdirect.org
  • Direct secure messaging: mwillerth3574@direct.unitypoint.org

Ownership & related parties

All facility ownership & control disclosures 14

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Trinity Regional Medical CenterFort Dodge, IA, CCN 160016 Hospital Corporate Director Jan 1, 2013
Unitypoint Clinic Family Medicine Second Avenue NorthFort Dodge, IA, CCN 168599 Rural health clinic Corporate Director Jan 1, 2013
Unitypoint Clinic Family Medicine Sac CitySac City, IA, CCN 168600 Rural health clinic Corporate Director Jan 1, 2013
Unitypoint Clinic - Kenyon RoadFort Dodge, IA, CCN 168604 Rural health clinic Corporate Director Jan 1, 2013
Unitypoint Clinic Family Medicine MansonManson, IA, CCN 168606 Rural health clinic Corporate Director Jan 1, 2013
Unitypoint Clinic Family Medicine PocahontasPocahontas, IA, CCN 168598 Rural health clinic Corporate Director Jan 1, 2013
Unitypoint Clinic Family Medicine HumboldtHumboldt, IA, CCN 168597 Rural health clinic Corporate Director Jan 1, 2013
Unitypoint Clinic Family Medicine Lake ViewLake View, IA, CCN 168605 Rural health clinic Corporate Director Jan 1, 2013
Unitypoint Clinic Family Medicine LaurensLaurens, IA, CCN 168596 Rural health clinic Corporate Director Jan 1, 2013
Unitypoint Clinic Family Medicine Eagle GroveEagle Grove, IA, CCN 168601 Rural health clinic Corporate Director Jan 1, 2013
Unitypoint Clinic Pediatrics Fort DodgeFort Dodge, IA, CCN 168603 Rural health clinic Corporate Director Jan 1, 2013
Unitypoint Clinic Family Health Center - Storm LakeStorm Lake, IA, CCN 168613 Rural health clinic Corporate Director Jan 1, 2013
Unitypoint Clinic Family Medicine - Buena VistaStorm Lake, IA, CCN 168612 Rural health clinic Corporate Director Jan 1, 2013
Unitypoint Clinic - Express in Fort DodgeFort Dodge, IA, CCN 168658 Rural health clinic Corporate Director Jan 1, 2013

Owned or controlled facilities with NPI records 14

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 14

Organizations & group practices 9

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 5

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

NPI Registry JSON

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

{
    "created_epoch": "1138924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482364800000",
    "number": "1316919202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 N 9TH ST",
            "address_2": "SUITE A",
            "city": "FORT DODGE",
            "state": "IA",
            "postal_code": "505013909",
            "telephone_number": "515-574-6890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 KENYON RD",
            "city": "FORT DODGE",
            "state": "IA",
            "postal_code": "505015742",
            "telephone_number": "515-574-6865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLERTH",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-03",
        "last_updated": "2016-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IA",
            "license": "31679",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Dodge, IA

Sources for this page

Verify at the official NPI Registry.