THERON WAISATH DMD
NPI 1144423963
Dentist - Oral and Maxillofacial Surgery in Champaign, IL

Q: What is Theron Waisath's NPI number?

The NPI number for Theron Waisath is 1144423963. It was assigned to this individual provider in the NPPES registry on June 8, 2007.

Q: What is Theron Waisath's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Q: When was this NPI record last updated?

The NPPES record for Theron Waisath was last updated on July 23, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years 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 June 08, 2007PECOS EnrolledAccepts Medicare Assignment

3112 VILLAGE OFFICE PL, CHAMPAIGN, IL 61822(217) 351-7111(217) 351-7282 Get Directions Write a Review

NPPES record last updated: July 23, 2009. Verified against the NPPES registry weekly; last sync: October 04, 2026.

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About Theron Waisath Dmd NPPES

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

THERON WAISATH DMD (NPI 1144423963) is an individual oral and maxillofacial surgery provider in Champaign, Illinois, licensed in Illinois (019.027879) and active in the NPI registry since June 2007. He is enrolled in Medicare PECOS and is a graduate of Southern Illinois Univ School Of Dental Medicine (2004).

NPPES Registry Identity

NPI1144423963

Entity TypeIndividualMale

Primary Taxonomy1223S0112X

Provider Legal NameTHERON WAISATHCredential: DMD

Location Address3112 VILLAGE OFFICE PLChampaign, IL 61822-7680

Mailing Address3112 Village Office PlChampaign, IL 61822-7680 · (217) 351-7111 · Fax (217) 351-7282

Phone(217) 351-7111

Fax(217) 351-7282

Sole ProprietorYes

Medical School CMSSouthern Illinois Univ School Of Dental MedicineGraduated 2004

Enumeration DateJune 8, 2007

Last NPPES UpdateJuly 23, 2009

✔ NPI 1144423963 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers

Taxonomy Code1223S0112X

License✔ Licensed in IL · 019.027879

Definition

An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

Also ListedOral & Maxillofacial SurgeryTaxonomy 204E00000X · License 2422 (OH)

3112 VILLAGE OFFICE PL, Champaign, IL 61822

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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

Theron Waisath Dmd 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 ID446433759

PECOS Enrollment IDI20110324000222

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 61822 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

$85.71 typical visit price

range $54.80 – $168.44

Typical copayment $21.42 (range $13.70 – $42.11)

Most-billed visit code 99203

Established Patient

$68.64 typical visit price

range $17.16 – $136.56

Typical copayment $17.16 (range $4.29 – $34.14)

Most-billed visit code 99213

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

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

AFFILIATES IN ORAL & MAXILLOFACIAL SURGERY LTD

Dentist (Oral and Maxillofacial Surgery)

3112 VILLAGE OFFICE PL
CHAMPAIGN, IL 61822

Champaign County (217) 351-7111

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Theron Waisath's NPI number?

The NPI number for Theron Waisath is 1144423963. It was assigned to this individual provider in the NPPES registry on June 8, 2007.

Where is Theron Waisath located?

Theron Waisath practices at 3112 Village Office Pl, Champaign, IL 61822. The listed phone number is (217) 351-7111.

What is Theron Waisath's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Is Theron Waisath enrolled in Medicare?

Yes. Theron Waisath is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Theron Waisath was last updated on July 23, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years 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.