Individual provider Active NPI

Wayne Lee Wasemiller, MD

  • Neurology Physician
  • Oklahoma City, OK
National Provider Identifier
1396717310
Registry record updated Jun 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
10843 Issued in OK
Practice address
4120 W Memorial Rd
Suite 218
Oklahoma City, OK 73120-9320
Phone
(405) 302-2661
Fax
(405) 302-2670
NPI assigned
Feb 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 10843 OK Primary

Addresses

Primary practice location

4120 W Memorial Rd
Suite 218
Oklahoma City, OK 73120-9320

Mailing address

4120 W Memorial Rd
Suite 218
Oklahoma City, OK 73120-9320
Phone (405) 302-2661

Other identifiers 1

IdentifierTypeStateIssuer
100129160AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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

Enrollment IDStateProvider typePAC IDDetails
I20090303000318 OK Practitioner - Neurology 5890778708 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10843OKMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Oklahoma Communities CurrentSince Jan 1, 2011 Accepting new patients
Summit Medical Center Past Accepting new patients
Mercy Health Network Inc Past Accepting new patients

Locations

530 N Monte Vista St
Ste A
Ada, OK 74820
Phone (580) 310-9510

4300 W Memorial Rd
Oklahoma City, OK 73120
Phone (405) 752-3962

8325 NW Expressway
Oklahoma City, OK 73162
Phone (405) 728-8000

4120 W Memorial Rd
Ste 218
Oklahoma City, OK 73120
Phone (405) 302-2661

4300 McAuley Blvd
Oklahoma City, OK 73120
Phone (405) 936-5455

Interoperability endpoints

  • Direct secure messaging: wwasemiller35216@directa.mercy.net

Organizations & group practices 3

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.

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": "1465516800000",
    "number": "1396717310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4120 W MEMORIAL RD",
            "address_2": "SUITE 218",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731209320",
            "telephone_number": "405-302-2661",
            "fax_number": "405-302-2670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4120 W MEMORIAL RD",
            "address_2": "SUITE 218",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731209320",
            "telephone_number": "405-302-2661",
            "fax_number": "405-302-2670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASEMILLER",
        "first_name": "WAYNE",
        "middle_name": "LEE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-03",
        "last_updated": "2016-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "OK",
            "license": "10843",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100129160A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.