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DR. OTTO WILLIAM WICKSTROM M.D. NPI 1487826939


NPI Information

NPI: 1487826939
Provider Name: DR. OTTO WILLIAM WICKSTROM, M.D.
Classification: Orthopaedic Surgery - 207XS0106X
Entity Type: Individual

Specialization: Hand Surgery

PECOS Registration: Yes

Address:
583 S CLARIZZ BLVD
BLOOMINGTON, IN
ZIP 47401
Phone: (812) 333-2663
Get Directions

DR. Otto William Wickstrom, M.D. is a hand surgery orthopaedic surgery in Bloomington, IN with 21 years of experience. The provider is an orthopaedic surgeon trained in the investigation, preservation and restoration by medical, surgical and rehabilitative means of all structures of the upper extremity directly affecting the form and function of the hand and wrist. DR. Otto William Wickstrom, M.D. NPI is 1487826939. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

583 S CLARIZZ BLVD
BLOOMINGTON, IN
ZIP 47401-515
Phone: (812) 333-2663
Fax: (812) 349-9206

The NPI 1487826939 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • X-ray of wrist, minimum of 3 views (HCPCS:73110)
  • X-ray of hand, minimum of 3 views (HCPCS:73130)
  • X-ray of fingers, minimum of 2 views (HCPCS:73140)
  • Injection, triamcinolone acetonide, not otherwise specified, 10 mg (HCPCS:J3301)
  • Injections of tendon sheath, ligament, or muscle membrane (HCPCS:20550)

The enumeration date for this NPI number is 3/25/2008 and was last updated on 4/29/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1174400000XSpecialist01065381AINDIANANo
2207X00000XOrthopaedic SurgeryMD61074238WASHINGTONNo
3207XS0106XOrthopaedic SurgeryHand SurgeryMD61074238WASHINGTONYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1200931500MEDICAIDINDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.