| Dr John M Wieland, MD | |
|
1505 Eastland Dr, Suite 2300, Bloomington, IL 61701-3534 | |
| (309) 662-9022 | |
| (309) 662-2091 |
| Full Name | Dr John M Wieland |
|---|---|
| Gender | Male |
| Speciality | General Surgery |
| Experience | 39 Years |
| Location | 1505 Eastland Dr, Bloomington, 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. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790717387 | NPI | - | NPPES |
| 036078215 | Other | ID | PUBLIC AID |
| 05700305 | Other | IL | BLUE CROSS BLUE SHIELD |
| 833120 | Other | MEDICARE GROUP # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208600000X | Surgery | 036078215 (Illinois) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Advocate Bromenn Medical Center | Normal, IL | Hospital |
| Advocate Eureka Hospital | Eureka, IL | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Carle West Physician Group Inc | 8921420308 | 275 |
| Entity Name | Carle Eureka Hospital |
|---|---|
| Entity Type | Part A Provider - Critical Access Hospital |
| Entity Identifiers | NPI Number: 1184644023 PECOS PAC ID: 3870914393 Enrollment ID: O20200609000028 |
| Entity Name | Carle West Physician Group Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1467074138 PECOS PAC ID: 8921420308 Enrollment ID: O20200613000147 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr John M Wieland, MD 611 W. Park St., Fapc, Urbana, IL 61801 Ph: () - | Dr John M Wieland, MD 1505 Eastland Dr, Suite 2300, Bloomington, IL 61701-3534 Ph: (309) 662-9022 |
Dr. Jeffrey Scott Poulter, M.D. Surgery Medicare: Not Enrolled in Medicare Practice Location: 1505 Eastland Dr, Ste 350, Bloomington, IL 61701 Phone: 309-663-1222 Fax: 309-663-0580 | |
Lawrence Alan Raines, MD Surgery Medicare: Not Enrolled in Medicare Practice Location: 1404 Eastland Dr, Ste 104, Bloomington, IL 61701 Phone: 309-663-4351 Fax: 309-663-8359 | |
Dr. John Stephen Esch, M.D. Surgery Medicare: Not Enrolled in Medicare Practice Location: 1505 Eastland Dr, Suite 2300, Bloomington, IL 61701 Phone: 309-662-9022 Fax: 309-662-2091 |