NPIMap

Individual provider Active NPI

Alexander Waldherr, DO

  • Sports Medicine (Family Medicine) Physician
  • Olney, IL
National Provider Identifier
1457939704
Registry record updated Oct 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
036.170058 Issued in IL
Practice address
504 Micah Dr
Olney, IL 62450-4720
Phone
(618) 388-3128
Fax
(618) 388-3127
NPI assigned
Mar 30, 2021
Last updated
Oct 22, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 02007147B IN
Family Medicine Physician 207Q00000X 036.170058 IL
Sports Medicine (Family Medicine) Physician 207QS0010X 036.170058 IL Primary

Addresses

Primary practice location

504 Micah Dr
Olney, IL 62450-4720

Mailing address

504 Micah Dr
Olney, IL 62450-4720
Phone (618) 388-3128

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20240816003906 IL Practitioner - Family PracticePractitioner - Sports Medicine 8527469048 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
Marian University College of Osteopathic Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wabash General Hospital DistrictGroup PAC ID 8022908185, 77 clinicians

Practice addresses (Care Compare)

1418 College Dr
Mount Carmel, IL 62863-2638
Phone (618) 262-8621

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.170058ILMDFamily Medicine Physician
02007147BINMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wabash General Hospital District Current Accepting new patients
Memorial Health Partners Family Medicine Current Accepting new patients
Board of Trustees of Southern Illinois University Family Medicine CurrentSince Jul 1, 2024 Accepting new patients
Board of Trustees of Southern Illinois University CurrentSince Jul 1, 2024 Accepting new patients
Wabash General Hospital District CurrentSince Jul 1, 2025 Accepting new patients
Wabash General Hospital District CurrentSince Jul 1, 2025 Accepting new patients
Major Hospital Past Accepting new patients
Wabash General Hospital District Past Accepting new patients

Locations

1418 College Dr
Mount Carmel, IL 62863
Phone (618) 262-8621

1525 College Dr
Mount Carmel, IL 62863
Phone (618) 263-6343

504 Micah Dr
Olney, IL 62450
Phone (618) 395-4306

520 N 4th St
Springfield, IL 62702
Phone (217) 757-8100

Interoperability endpoints

  • Direct secure messaging: alexanderwaldherr@memorial.allscriptsdirect.net
  • Direct secure messaging: awaldherr588505@direct.franciscanalliance.org

Organizations & group practices 8

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.

Hospital & facility affiliations 4

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": "1617062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761091200000",
    "number": "1457939704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 MICAH DR",
            "city": "OLNEY",
            "state": "IL",
            "postal_code": "624504720",
            "telephone_number": "618-388-3128",
            "fax_number": "618-388-3127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 MICAH DR",
            "city": "OLNEY",
            "state": "IL",
            "postal_code": "624504720",
            "telephone_number": "618-388-3128",
            "fax_number": "618-388-3127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDHERR",
        "first_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-30",
        "last_updated": "2025-10-22",
        "certification_date": "2025-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02007147B",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.170058",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "IL",
            "license": "036.170058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olney, IL

Sources for this page

Verify at the official NPI Registry.