Luke Wibowo, MD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

35.068054 Issued in OH

Practice address

1 Wyoming St
Dayton, OH 45409-2722

Phone

(937) 208-2978

Fax

(937) 208-6137

NPI assigned

Sep 14, 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

Other identifiers 1

Other names 1

• Achmad Wibowo Former name

Medicare fee-for-service enrollment

Enrolled in OH

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

Pathology

Education

Other, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Valley Pathologists, IncGroup PAC ID 7214821289, 11 clinicians

Digestive Specialists IncGroup PAC ID 2062300809, 25 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Miami Valley Hospital Hospital, Dayton, OH, CCN 360051
• Atrium Medical Center Hospital, Franklin, OH, CCN 360076
• Upper Valley Medical Center Hospital, Troy, OH, CCN 360174

Merit-based Incentive Payment System (MIPS)

Final score

95.84 of 100Reported as group

Quality

92.44

Promoting interoperability

100

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

98.7 of 100Reported as group

Quality

95

Improvement activities

40

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.

• Digestive Specialists Inc

  • Gastroenterology Physician
  • Dayton, OH
  • NPI 1770556532
  Medicare reassignment Care Compare group NPD
• Valley Pathologists, Inc.

  • Anatomic Pathology & Clinical Pathology Physician
  • Dayton, OH
  • NPI 1992798854
  Medicare reassignment Care Compare group NPD
• Challa Ajit, M.D. LLC

  • Gastroenterology Physician
  • Springfield, OH
  • NPI 1629142815
  Medicare reassignment NPD
• Gcga Physicians Inc.

  • Gastroenterology Physician
  • Cincinnati, OH
  • NPI 1790851095
  NPD (past)

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

• Atrium Medical Center

  • General Acute Care Hospital
  • Franklin, OH
  • NPI 1700950060
  Care Compare affiliation
• Miami Valley Hospital

  • General Acute Care Hospital
  • Dayton, OH
  • NPI 1073688354
  Care Compare affiliation
• Upper Valley Medical Center

  • General Acute Care Hospital
  • Troy, OH
  • NPI 1184638942
  Care Compare affiliation

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

{
    "created_epoch": "1126656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674777600000",
    "number": "1861487068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 20452",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432200452",
            "telephone_number": "614-457-8180",
            "fax_number": "614-583-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WYOMING ST",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454092722",
            "telephone_number": "937-208-2978",
            "fax_number": "937-208-6137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIBOWO",
        "first_name": "LUKE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-14",
        "last_updated": "2023-01-27",
        "certification_date": "2023-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "OH",
            "license": "35.068054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0338469",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ACHMAD",
            "last_name": "WIBOWO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Tamara D Whitt, SRNA
• Chelsea Rae Whittington, CPRS
• Kimberly Ann Whittington, CPRS
• Samantha Whittington
• Giana Monique Whorton
• Daniel Wick
• Tracy Katherine Wick, MD
• Angela Wicker
• Lisa Wickham
• James Eric Wickline, MPT

• Anatomic Pathology & Clinical Pathology Physician in Dayton, OH
• Providers in Dayton, OH by specialty
• Anatomic Pathology & Clinical Pathology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2023; 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.