Robert C. Wanless, M.D.

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

036 - 052657 Issued in IL

Practice address

4600 Memorial Dr
Suite 320
Belleville, IL 62226-5366

Phone

(618) 257-2100

Fax

(618) 257-2169

NPI assigned

Oct 6, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

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.

• Plastic Surgery Consultants, P.C.

  • Plastic Surgery Physician
  • Belleville, IL
  • NPI 1578551065
  NPD (past) Authorized official
• Protestant Memorial Medical Center, Inc.

  • Community/Retail Pharmacy
  • Shiloh, IL
  • NPI 1154172211
  NPD (past)

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

{
    "created_epoch": "1128556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395273600000",
    "number": "1548258288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 MEMORIAL DR",
            "address_2": "SUITE 320",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265366",
            "telephone_number": "618-257-2100",
            "fax_number": "618-257-2169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 MEMORIAL DR",
            "address_2": "SUITE 320",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265366",
            "telephone_number": "618-257-2100",
            "fax_number": "618-257-2169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANLESS",
        "first_name": "ROBERT",
        "middle_name": "C.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-06",
        "last_updated": "2014-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "IL",
            "license": "036 - 052657",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036052657",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Wallace, M.D.
• Tamara Jean Walls, MD
• Walmart Inc.
• Stacie L Walter, O.T.
• Andy Wang, MD
• Jerome Stephen Warchol Sr., D.M.D.
• Carla Ward, D.C.
• Diane Carrie Warfield, DT
• Daniel R Warner, CRNA
• Lori S Warner, CRNA

• Plastic Surgery Physician in Belleville, IL
• Providers in Belleville, IL by specialty
• Plastic Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.