Individual provider Active NPI

Diane G Wilson, O.D.

  • Optometrist
  • Arnold, MO
National Provider Identifier
1841236635
Registry record updated Dec 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
T02765 Issued in MO
Practice address
1235 Water Tower PL
Arnold, MO 63010-2142
Phone
(636) 296-8612
Fax
(636) 296-8055
NPI assigned
Jun 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2008

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X T02765 MO Primary
Vision Therapy Optometrist 152WV0400X T02765 MO
Pediatric Optometrist 152WP0200X T02765 MO

Addresses

Primary practice location

1235 Water Tower PL
Arnold, MO 63010-2142

Mailing address

7 Huntleigh Woods
Barnhart, MO 63012-1349
Phone (636) 296-8612

Other identifiers 4

IdentifierTypeStateIssuer
108374OtherMOBLUE CROSS/BLUE SHIELD
22-02076OtherMOUNITED HEALTHCARE
401231OtherMOGROUP HEALTH PLAN
20717OtherMOBLUE CHOICE

Other names 1

  • Dr. Diane G Werkmeister Former name

Medicare participation

Medicare enrollment files
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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100513001043 MO Practitioner - Optometry 7416020235 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Missouri St Louis - School of Optometry, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Diane G. Wilson, OD and Associates, PCGroup PAC ID 6608949425, 3 clinicians

Practice addresses (Care Compare)

1235 Water Tower PL
Arnold, MO 63010-2142
Phone (636) 296-8612

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery24

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
T02765MOMDPediatric Optometrist

Interoperability endpoints

  • Direct secure messaging: direct@arnoldeyecenterarnoldmo.compulinkdirect.com

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1229904000000",
    "number": "1841236635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 HUNTLEIGH WOODS",
            "city": "BARNHART",
            "state": "MO",
            "postal_code": "630121349",
            "telephone_number": "636-296-8612",
            "fax_number": "636-296-8055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 WATER TOWER PL",
            "city": "ARNOLD",
            "state": "MO",
            "postal_code": "630102142",
            "telephone_number": "636-296-8612",
            "fax_number": "636-296-8055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "DIANE",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-21",
        "last_updated": "2008-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "T02765",
            "primary": true
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "MO",
            "license": "T02765",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "MO",
            "license": "T02765",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "108374",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "22-02076",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH PLAN",
            "identifier": "401231",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE",
            "identifier": "20717",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIANE",
            "last_name": "WERKMEISTER",
            "middle_name": "G",
            "prefix": "DR.",
            "credential": "O.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Arnold, MO

Sources for this page

Verify at the official NPI Registry.