EMILY LOUISE WICKERSHAM DO
NPI 1093175358
Pathology - Anatomic Pathology & Clinical Pathology in Bolivar, MO

Q: What is Emily Wickersham's NPI number?

The NPI number for Emily Wickersham is 1093175358. It was assigned to this individual provider in the NPPES registry on February 29, 2016.

Q: What is Emily Wickersham's specialty?

The primary specialty registered for this NPI is Pathology, specializing in Anatomic Pathology & Clinical Pathology, with taxonomy code 207ZP0102X.

Q: When was this NPI record last updated?

The NPPES record for Emily Wickersham was last updated on January 15, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since February 29, 2016PECOS EnrolledAccepts Medicare Assignment

1500 N OAKLAND AVE, BOLIVAR, MO 65613(417) 326-6000 Get Directions Write a Review

NPPES record last updated: January 15, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 15, 2026, Dec 6, 2022, Jul 8, 2020 and 1 more (4 updates tracked since 2016).

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About Emily Louise Wickersham Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EMILY LOUISE WICKERSHAM DO (NPI 1093175358) is an individual anatomic pathology & clinical pathology provider in Bolivar, Missouri, licensed in Missouri (2024028249) and active in the NPI registry since February 2016. She is enrolled in Medicare PECOS, is affiliated with Citizens Memorial Hospital, and is a graduate of Other (2020).

NPPES Registry Identity

NPI1093175358

Entity TypeIndividualFemale

Primary Taxonomy207ZP0102X

Provider Legal NameEMILY LOUISE WICKERSHAMCredential: DO

Location Address1500 N OAKLAND AVEBolivar, MO 65613-3099

Mailing Address19135 Pawnee CtSaint Joseph, MO 64505-8901 · (309) 258-5813

Phone(417) 326-6000

Sole ProprietorNo

Medical School CMSOtherGraduated 2020

Enumeration DateFebruary 29, 2016

Last NPPES UpdateJanuary 15, 20264 updates tracked since enumeration

NPPES CertifiedJanuary 15, 2026

✔ NPI 1093175358 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPathology · Anatomic Pathology & Clinical PathologyAllopathic & Osteopathic Physicians

Taxonomy Code207ZP0102X

Licenses✔ Licensed in MO · 2024028249✔ Licensed in IL · 036.177695

Definition

A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease.

1500 N OAKLAND AVE, Bolivar, MO 65613

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Medica.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Emily Louise Wickersham Do is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID143755124

PECOS Enrollment IDI20241127003054

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Pathology examination of tissue using a microscope, intermediate complexity 88305

A pathology examination of tissue with intermediate complexity involves studying a small sample of your body tissue under a microscope. This helps in identifying any abnormal cells or signs of disease. It's a detailed process requiring expert analysis to ensure accurate results.

46 services19 patients

Pathology examination of tissue using a microscope, intermediate complexity 88305

39 services24 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Citizens Memorial Hospital

Acute Care Hospitals · Bolivar, MO

4/5 CMS rating

OwnershipGovernment - Hospital District or Authority

CMS Certification Number260195

Location1500 N OaklandBolivar, MO 65613 · Polk County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 65613 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$121.96 typical visit price

range $52.28 – $161.24

Typical copayment $30.49 (range $13.07 – $40.31)

Most-billed visit code 99204

Established Patient

$93.24 typical visit price

range $16.30 – $131.05

Typical copayment $23.31 (range $4.07 – $32.76)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JACOB PODLESKI

Anesthesiology