Timothy M Riesenberger, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

66176 Issued in AZ

Practice address

820 N Chelan Ave
Wenatchee, WA 98801-2028

Phone

(509) 663-8711

NPI assigned

Jun 11, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GU, IL, AZ, TN, KY, NM, LA7 enrollments

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 7

Specialty

Emergency Medicine

Education

Loma Linda University School of Medicine, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Central Prairie Physicians PLLCGroup PAC ID 9032615059, 23 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• MC Donough District Hospital Hospital, Macomb, IL, CCN 140089

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Central Prairie Physicians PLLC

  • Emergency Medicine Physician
  • Lubbock, TX
  • NPI 1821884750

  IL, Multi-Specialty

  Medicare reassignment Care Compare group NPD
• App of Tennessee Ed, PLLC

  • Emergency Medicine Physician
  • Maryville, TN
  • NPI 1003230236

  Multi-Specialty, TN

  Medicare reassignment NPD
• Emergency Services Midwest SC

  • Emergency Medicine Physician
  • Belleville, IL
  • NPI 1174024806

  IL, Multi-Specialty

  Medicare reassignment NPD
• Fedko Emergency Physicians New Mexico LLC

  • Emergency Medicine Physician
  • Grants, NM
  • NPI 1770047441

  Multi-Specialty, NM

  Medicare reassignment NPD
• Fep of Kentucky LLC

  • Emergency Medicine Physician
  • Hopkinsville, KY
  • NPI 1770266553

  KY, Multi-Specialty

  Medicare reassignment NPD
• General Conference Corp of Sda

  • Clinic/Center
  • Tamuning, GU
  • NPI 1275586877

  GU, Multi-Specialty

  Medicare reassignment NPD
• Guam Healthcare Development Incorporated

  • Clinic/Center
  • Dededo, GU
  • NPI 1326447939

  GU, Multi-Specialty

  Medicare reassignment NPD
• Morehouse General Hospital

  • Multi-Specialty Clinic/Center
  • Bastrop, LA
  • NPI 1790966638

  LA, Multi-Specialty

  Medicare reassignment NPD
• Progressive Medical Associates PLLC

  • Emergency Medicine Physician
  • Mesa, AZ
  • NPI 1548218613

  AZ, Multi-Specialty

  Medicare reassignment NPD
• Morehouse General Hospital

  • Rural Health Clinic/Center
  • Bastrop, LA
  • NPI 1992207294
  NPD
• Lewis County Emergency Physicians

  • Emergency Medicine Physician
  • Centralia, WA
  • NPI 1174555684

  Multi-Specialty

  NPD (past)
• West Sound Emergency Physicians, PLLC

  • Emergency Medicine Physician
  • Silverdale, WA
  • NPI 1568489243

  Multi-Specialty

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• McDonough County Hospital District

  • General Acute Care Hospital
  • Macomb, IL
  • NPI 1669420766

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653004800000",
    "number": "1689616302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "388 YPAO RD",
            "city": "TAMUNING",
            "state": "GU",
            "postal_code": "969133701",
            "telephone_number": "671-646-8881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 N CHELAN AVE",
            "city": "WENATCHEE",
            "state": "WA",
            "postal_code": "988012028",
            "telephone_number": "509-663-8711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIESENBERGER",
        "first_name": "TIMOTHY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-11",
        "last_updated": "2022-05-20",
        "certification_date": "2022-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": "GU",
            "license": "M-2172",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WA",
            "license": "MD00044765",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "65745",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "KY",
            "license": "C0654",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AZ",
            "license": "66176",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1689616302",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Wenatchee, WA
• Emergency Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.