Mauricio Wiltz, D.D.S.

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

043995 Issued in NY

Practice address

3332 Rochambeau Avenue
Department of Dentistry, 2ND Floor
Bronx, NY 10467-2836

Phone

(718) 920-4984

Fax

(718) 515-5419

NPI assigned

May 27, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

Oral SurgeryAlso: Maxillofacial Surgery

Education

New York University College of Dentistry, 1991

Medicare assignment

May accept Medicare assignment

Group practices

Montefiore Medical CenterGroup PAC ID 3779496021, 2,809 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H9678

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.

• Montefiore Medical Center

  • Dentist
  • Bronx, NY
  • NPI 1275710519

  Oral and Maxillofacial Surgery

  Medicare reassignment Care Compare group NPD
• Montefiore Medical Center

  • Community/Retail Pharmacy
  • Bronx, NY
  • NPI 1194183715
  NPD
• Montefiore Dental Department

  • Dentist
  • Bronx, NY
  • NPI 1588867055
  NPD (past)

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

{
    "created_epoch": "1117152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574726400000",
    "number": "1760485247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36 HALSTEAD AVE",
            "city": "YONKERS",
            "state": "NY",
            "postal_code": "107043008",
            "telephone_number": "914-237-9094",
            "fax_number": "718-515-5419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3332 ROCHAMBEAU AVENUE",
            "address_2": "DEPARTMENT OF DENTISTRY, 2ND FLOOR",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672836",
            "telephone_number": "718-920-4984",
            "fax_number": "718-515-5419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILTZ",
        "first_name": "MAURICIO",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-05-27",
        "last_updated": "2019-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "043995",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "NY",
            "license": "043995",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01763744",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stacy Wilson
• Stephanie Wilson, LCSWR
• Tele Corinne Wilson, LCSW
• Teresa Ann Wilson, CPNP
• Tshura Shantana Wilson, MS, FNP-BC
• Genesis Kiana Wimmer, RN
• Sheila Wimmer
• Aye Mon Win, DO
• Nyunt Win, MD
• Madelynn Windberg

• Oral & Maxillofacial Surgery (D.M.D.) in Bronx, NY
• Providers in Bronx, NY by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2019; 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.