NPIMap

Individual provider Active NPI

Michael John Wheatley, MD

  • Surgery of the Hand (Plastic Surgery) Physician
  • Portland, OR
National Provider Identifier
1376658773
Registry record updated Oct 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery of the Hand (Plastic Surgery) PhysicianTaxonomy code 2082S0105X
License
DR.0059470 Issued in CO
Practice address
501 N Graham St
Suite 330
Portland, OR 97227-1654
Phone
(503) 413-3650
Fax
(503) 413-3644
NPI assigned
Aug 19, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 23, 2018

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X 17999 OR
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician 2082S0099X MD17999 OR
Surgery of the Hand (Plastic Surgery) Physician 2082S0105X MD17999 OR
Surgery of the Hand (Plastic Surgery) Physician 2082S0105X DR.0059470 CO Primary

Addresses

Primary practice location

501 N Graham St
Suite 330
Portland, OR 97227-1654

Mailing address

9440 NW Lightning Ridge Dr
Portland, OR 97229-2633
Phone (503) 292-8062

Other identifiers 1

IdentifierTypeStateIssuer
MD17999OtherOROREGON STATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, CO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130626000006 OR Practitioner - Plastic and Reconstructive Surgery 9537308408 Reassigns benefits to 1 organization
I20181107001879 CO Practitioner - Hand SurgeryPractitioner - Plastic and Reconstructive Surgery 9537308408 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hand SurgeryAlso: Plastic and Reconstructive Surgery
Education
University of Michigan Medical School, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

1400 E Boulder
Suite 2410 Pre Procedure Memorial
Colorado Springs, CO 80909-5533
Phone (719) 365-6525

1400 E Boulder St
Colorado Springs, CO 80909-5533

4404 Barranca LN
Unit 101
Castle Rock, CO 80104-7419
Phone (720) 733-5260

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
17999ORMDPlastic Surgery Physician
MD17999ORMDSurgery of the Hand (Plastic Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC Plastic Surgery CurrentSince Sep 23, 2018 Accepting new patients
Poudre Valley Medical Group, LLC CurrentSince Sep 23, 2018 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Mar 9, 2019 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Current Accepting new patients

Locations

4404 Barranca Ln
Castle Rock, CO 80104
Phone (720) 733-5260

175 S Union Blvd
Ste 125
Colorado Springs, CO 80910

175 S Union Blvd
Ste 300
Colorado Springs, CO 80910
Phone (719) 365-6363

8890 N Union Blvd
Ste 171
Colorado Springs, CO 80920
Phone (719) 364-4120

175 S Union Blvd
Ste 310
Colorado Springs, CO 80910
Phone (719) 365-6363

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

7201 N Interstate Ave
Portland, OR 97217
Phone (503) 240-4051

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

Organizations & group practices 4

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 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540252800000",
    "number": "1376658773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9440 NW LIGHTNING RIDGE DR",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972292633",
            "telephone_number": "503-292-8062",
            "fax_number": "503-608-4083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 N GRAHAM ST",
            "address_2": "SUITE 330",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972271654",
            "telephone_number": "503-413-3650",
            "fax_number": "503-413-3644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHEATLEY",
        "first_name": "MICHAEL",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-19",
        "last_updated": "2018-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "OR",
            "license": "17999",
            "primary": false
        },
        {
            "code": "2082S0099X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery, Plastic Surgery Within the Head and Neck",
            "state": "OR",
            "license": "MD17999",
            "primary": false
        },
        {
            "code": "2082S0105X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery, Surgery of the Hand",
            "state": "OR",
            "license": "MD17999",
            "primary": false
        },
        {
            "code": "2082S0105X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery, Surgery of the Hand",
            "state": "CO",
            "license": "DR.0059470",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON STATE LICENSE",
            "identifier": "MD17999",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.