Individual provider Active NPI

Bryan Wilhelm, DPM

  • Podiatrist
  • Bend, OR
National Provider Identifier
1427060565
Registry record updated Jul 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
DP00214 Issued in OR
Practice address
1510 SW Nancy Way Ste 2
Bend, OR 97702-3256
Phone
(541) 385-7129
Fax
(541) 385-7138
NPI assigned
Aug 13, 2006
Last updated
Jul 22, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X DP00214 OR Primary
Foot & Ankle Surgery Podiatrist 213ES0103X DP00214 OR

Addresses

Primary practice location

1510 SW Nancy Way Ste 2
Bend, OR 97702-3256

Mailing address

1510 SW Nancy Way Ste 2
Bend, OR 97702-3256
Phone (541) 385-7129

Other identifiers 3

IdentifierTypeStateIssuer
20-2456582OtherORTAX ID
865318004OtherORBLUE CROSS
014352MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040525000515 OR Practitioner - Podiatry 7618958984 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
California School of Podiatric Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northwest Footcare LLCGroup PAC ID 7113968256, 5 clinicians

Practice addresses (Care Compare)

1693 SW Chandler Ave
Suite 280
Bend, OR 97702-3231
Phone (541) 385-7129

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of nail tissue186
Removal or shaving of skin growth184
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DP00214ORMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Footcare, LLC Podiatrist CurrentSince Jul 1, 2005 Accepting new patients

Locations

1510 SW Nancy Way
Ste 2
Bend, OR 97702
Phone (541) 385-7129

1693 SW Chandler Ave
Ste 280
Bend, OR 97702
Phone (541) 318-1000

2090 NE Wyatt Ct
Ste 201
Bend, OR 97701
Phone (541) 385-7129

51600 Huntington Rd
La Pine, OR 97739
Phone (541) 385-7129

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311292800000",
    "number": "1427060565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1510 SW NANCY WAY STE 2",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977023256",
            "telephone_number": "541-385-7129",
            "fax_number": "541-385-7138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 SW NANCY WAY STE 2",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977023256",
            "telephone_number": "541-385-7129",
            "fax_number": "541-385-7138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILHELM",
        "first_name": "BRYAN",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-13",
        "last_updated": "2011-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "OR",
            "license": "DP00214",
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "OR",
            "license": "DP00214",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "20-2456582",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "865318004",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "014352",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

Verify at the official NPI Registry.