Dr Thomas Oliver Wildes, MD is a medicare enrolled "Otolaryngology - Otolaryngology/facial Plastic Surgery" physician in Chippewa Falls, Wisconsin. His current practice location is
962 Parkland Dr, Chippewa Falls, Wisconsin. You can reach out to his office (for appointments etc.) via phone at
(608) 345-3677.
Dr Thomas Oliver Wildes is licensed to practice in Wisconsin (license number 26197-020) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1154393791.
Physician's Profile
| Full Name | Dr Thomas Oliver Wildes |
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| Gender | Male |
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| Speciality | Otolaryngology - Otolaryngology/facial Plastic Surgery |
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| Location | 962 Parkland Dr, Chippewa Falls, Wisconsin |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1154393791
- Provider Enumeration Date: 02/07/2006
- Last Update Date: 12/02/2011
Medicare PECOS Information:
- PECOS PAC ID: 4486606738
- Enrollment ID: I20130211000481
Medical Identifiers
Medical identifiers for Dr Thomas Oliver Wildes such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
| 1154393791 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
| 207YX0905X | Otolaryngology - Otolaryngology/facial Plastic Surgery | 26197-020 (Wisconsin) | Primary |
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. Dr Thomas Oliver Wildes allows following entities to bill medicare on his behalf.
| Entity Name | Banner Physician Specialists Arizona Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1316228802 PECOS PAC ID: 6204002272 Enrollment ID: O20111222000509 |
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| Entity Name | Banner - University Physician Specialists Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1437529245 PECOS PAC ID: 5991008054 Enrollment ID: O20160122001476 |
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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. Dr Thomas Oliver Wildes 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 |
Dr Thomas Oliver Wildes, MD 962 Parkland Dr, Chippewa Falls, WI 54729-5084 Ph: (608) 345-3677 | Dr Thomas Oliver Wildes, MD 962 Parkland Dr, Chippewa Falls, WI 54729-5084 Ph: (608) 345-3677 |
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