Gerald A Wankum, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

036079558 Issued in IL

Practice address

3 Professional Dr
Alton, IL 62002-5067

Phone

(618) 465-2020

Fax

(618) 465-2046

NPI assigned

May 27, 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

Medicare fee-for-service enrollment

Enrolled in MO

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Surevision Eye Centers Midwest LLC

  • Ophthalmology Physician
  • Creve Coeur, MO
  • NPI 1699857912
  Medicare reassignment

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

{
    "created_epoch": "1117152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340928000000",
    "number": "1689677254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 BROOKES DR",
            "address_2": "SUITE 111",
            "city": "HAZELWOOD",
            "state": "MO",
            "postal_code": "630422736",
            "telephone_number": "314-726-5669",
            "fax_number": "314-726-5109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 PROFESSIONAL DR",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620025067",
            "telephone_number": "618-465-2020",
            "fax_number": "618-465-2046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANKUM",
        "first_name": "GERALD",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-27",
        "last_updated": "2012-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IL",
            "license": "036079558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Elizabeth Walker, PT
• Shereece Nichole Wallace, DNP, AGPCNP-BC
• Courtney Wallendorff, BA
• Wang Cardiology LTD
• Peng Nan Wang, MD
• Elaina Ward
• Naomi Marie Ward, R. D., L. D. N.
• Pamela Lynn Ware, BS
• Laura Jean Warren-Cashman, APRN
• Urooj Wasey

• Ophthalmology Physician in Alton, IL
• Providers in Alton, IL by specialty
• Ophthalmology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.