Theron Waisath, DMD in Champaign, IL - Medicare Maxillofacial Surgery Provider

Theron Waisath, DMD is a medicare enrolled "Dentist - Oral And Maxillofacial Surgery" provider in Champaign, Illinois. He went to Southern Illinois Univ School Of Dental Medicine and graduated in 2004 and has 20 years of diverse experience with area of expertise as Maxillofacial Surgery. He is a member of the group practice Affiliates In Oral And Maxillofacial Surgery Ltd and his current practice location is 3112 Village Office Pl, Champaign, Illinois. You can reach out to his office (for appointments etc.) via phone at (217) 351-7111.

Theron Waisath is licensed to practice in Illinois (license number 019.027879) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1144423963.

Contact Information

	Theron Waisath, DMD
	3112 Village Office Pl, Champaign, IL 61822-7680
	(217) 351-7111
	(217) 351-7282

Map and Direction

Healthcare Provider's Profile

Full Name	Theron Waisath
Gender	Male
Speciality	Maxillofacial Surgery
Experience	20 Years
Location	3112 Village Office Pl, Champaign, Illinois
Accepts Medicare Assignments	Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Theron Waisath attended and graduated from Southern Illinois Univ School Of Dental Medicine in 2004

NPI Data:

NPI Number: 1144423963
Provider Enumeration Date: 06/08/2007
Last Update Date: 07/23/2009

Medicare PECOS Information:

PECOS PAC ID: 0446433759
Enrollment ID: I20110324000222

Medical Identifiers

Medical identifiers for Theron Waisath such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1144423963	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
1223S0112X	Dentist - Oral And Maxillofacial Surgery	019.027879 (Illinois)	Primary
204E00000X	Oral & Maxillofacial Surgery	2422 (Ohio)	Secondary

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Affiliates In Oral And Maxillofacial Surgery Ltd	0345309779	2

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Theron Waisath allows following entities to bill medicare on his behalf.

Entity Name	Affiliates In Oral & Maxillofacial Surgery Ltd
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1215196290 PECOS PAC ID: 0345309779 Enrollment ID: O20081030000231

Entity Name	Carle Health Care Incorporated
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1154653947 PECOS PAC ID: 3577515774 Enrollment ID: O20100513000829

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Theron Waisath is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Theron Waisath, DMD 3112 Village Office Pl, Champaign, IL 61822-7680 Ph: (217) 351-7111	Theron Waisath, DMD 3112 Village Office Pl, Champaign, IL 61822-7680 Ph: (217) 351-7111

Reviews and Comments

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Theron Waisath, DMD - Medicare Dentist in Champaign, IL