Individual provider Active NPI

Donald Walter Wendt, PA-C

  • Physician Assistant
  • Decatur, IL
National Provider Identifier
1710172325
Registry record updated Sep 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085003029 Issued in IL
Practice address
304 W Hay St
Ste 111
Decatur, IL 62526-6328
Phone
(217) 875-8100
Fax
(217) 872-5486
NPI assigned
Sep 7, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085003029 IL Primary

Addresses

Primary practice location

304 W Hay St
Ste 111
Decatur, IL 62526-6328

Mailing address

304 W Hay St
Ste 111
Decatur, IL 62526-6328
Phone (217) 875-8100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071025000025 IL Practitioner - Physician Assistant 8325135288 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Southern Illinois University School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Christie Clinic, PLLCGroup PAC ID 7719899319, 219 clinicians

Practice addresses (Care Compare)

101 W University Ave
Champaign, IL 61820-3909
Phone (217) 366-1200

109 W University Ave
Champaign, IL 61820-3909
Phone (217) 366-5180

1120 N Melvin St
Gibson City, IL 60936-1477
Phone (217) 784-4251

300 N Main St
Tuscola, IL 61953-1406
Phone (217) 253-9258

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Christie Clinic, PLLC CurrentSince Apr 5, 2021 Accepting new patients
Decatur Emergency Medical Services II S C Past Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

101 W University Ave
Champaign, IL 61820
Phone (217) 366-1255

3101 Fields South Dr
Champaign, IL 61822
Phone (217) 366-1237

3103 Fields South Dr
Champaign, IL 61822
Phone (217) 902-2300

1120 N Melvin St
Gibson City, IL 60936
Phone (217) 355-1684

Organizations & group practices 4

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 2

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": "1189123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378252800000",
    "number": "1710172325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 W HAY ST",
            "address_2": "STE 111",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625266328",
            "telephone_number": "217-875-8100",
            "fax_number": "217-872-5486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 W HAY ST",
            "address_2": "STE 111",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625266328",
            "telephone_number": "217-875-8100",
            "fax_number": "217-872-5486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WENDT",
        "first_name": "DONALD",
        "middle_name": "WALTER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-07",
        "last_updated": "2013-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085003029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, IL

Sources for this page

Verify at the official NPI Registry.