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Individual provider Active NPI

Jeffrey R Wichman, MD

  • Diagnostic Radiology Physician
  • Cape Girardeau, MO
National Provider Identifier
1619179991
Registry record updated May 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
2008003319 Issued in MO
Practice address
70 Doctors' Park
Cape Girardeau, MO 63703
Phone
(573) 334-6071
Fax
(573) 334-4739
NPI assigned
May 31, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 2008003319 MO Primary

Addresses

Primary practice location

70 Doctors' Park
Cape Girardeau, MO 63703

Mailing address

70 Doctors' Park
Cape Girardeau, MO 63703
Phone (573) 334-6071

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IL, KY3 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 3

Enrollment IDStateProvider typePAC IDDetails
I20080722000028 MO Practitioner - Diagnostic Radiology 6507959566 Reassigns benefits to 3 organizations
I20080725000169 IL Practitioner - Diagnostic Radiology 6507959566 Reassigns benefits to 1 organization
I20230509000591 KY Practitioner - Diagnostic Radiology 6507959566 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Saint Louis University School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cape Radiology Group PCGroup PAC ID 9830093236, 54 clinicians
Mercy Hospital PerryGroup PAC ID 1153777826, 115 clinicians

Practice addresses (Care Compare)

1200 N One Mile Rd
Dexter, MO 63841-1000
Phone (573) 614-1901

1530 Lone Oak Rd
Paducah, KY 42003-7901
Phone (270) 444-2444

1701 Lacey St
Cape Girardeau, MO 63701-5230
Phone (573) 651-5543

211 Saint Francis Dr
Cape Girardeau, MO 63703-5049
Phone (573) 331-3000

2970 S Hancock Hill Rd
Rocheport, MO 65279-9845
Phone (573) 335-6671

29882 State Hwy Y
Jonesburg, MO 63351-2914
Phone (573) 335-6671

3100 Oak Grove Rd
Poplar Bluff, MO 63901-1573
Phone (573) 776-2000

434 N W St
Perryville, MO 63775-1359
Phone (573) 547-2536

517 N Main St
Anna, IL 62906-1668
Phone (618) 833-4511

611 W Main St
Fredericktown, MO 63645-1146
Phone (573) 783-3341

70 Doctors Park
Cape Girardeau, MO 63703-4928
Phone (573) 334-6071

713 Stoney Creek LN
Ballwin, MO 63021-4235
Phone (573) 334-6071

800 Genevieve Dr
Sainte Genevieve, MO 63670-1434
Phone (573) 883-2851

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital Perry CurrentSince Oct 1, 2023 Accepting new patients
Mercy Hospital Perry CurrentSince Oct 1, 2023 Accepting new patients
Mercy Hospital Perry Diagnostic Radiology Current Accepting new patients
Indiana Radiology Partners, Inc Diagnostic Radiology Past Accepting new patients
Indiana University Radiology Associates, Inc. Diagnostic Radiology Past Accepting new patients

Locations

434 N West St
Perryville, MO 63775
Phone (573) 547-2530

Organizations & group practices 6

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 7

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": "1180569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620172800000",
    "number": "1619179991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 DOCTORS' PARK",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "63703",
            "telephone_number": "573-334-6071",
            "fax_number": "573-334-4739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 DOCTORS' PARK",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "63703",
            "telephone_number": "573-334-6071",
            "fax_number": "573-334-4739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICHMAN",
        "first_name": "JEFFREY",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-31",
        "last_updated": "2021-05-05",
        "certification_date": "2021-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "2008003319",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cape Girardeau, MO

Sources for this page

Verify at the official NPI Registry.