LARISSA WIETLISBACH - NPI 1982352597 - Plastic Surgery in Chicago, IL

Q: What is Larissa Wietlisbach's NPI number?

The NPI number for Larissa Wietlisbach is 1982352597. It was assigned to this individual provider in the NPPES registry on March 13, 2022.

Q: What is Larissa Wietlisbach's specialty?

The primary specialty registered for this NPI is Plastic Surgery with taxonomy code 208200000X.

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About Larissa Wietlisbach NPPES

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

LARISSA WIETLISBACH (NPI 1982352597) is an individual plastic surgery provider in Chicago, Illinois, licensed in Illinois (125082534) and active in the NPI registry since March 2022. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1982352597

Entity TypeIndividualFemale

Primary Taxonomy208200000X

Provider Legal NameLARISSA WIETLISBACH

Location Address5841 S MARYLAND AVE # MC6035Chicago, IL 60637-1443

Mailing Address180 Harvester Dr Ste 110Burr Ridge, IL 60527-6686 · (773) 702-1150

Phone(773) 702-6302

Sole ProprietorNo

Enumeration DateMarch 13, 2022

Last NPPES UpdateAugust 1, 20232 updates tracked since enumeration

NPPES CertifiedAugust 1, 2023

✔ NPI 1982352597 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPlastic SurgeryAllopathic & Osteopathic Physicians

Taxonomy Code208200000X

License✔ Licensed in IL · 125082534

Definition

A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well.

5841 S MARYLAND AVE # MC6035, Chicago, IL 60637

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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 (PECOS)

Larissa Wietlisbach is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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 60637 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

$94.06 typical visit price

range $60.08 – $183.39

Typical copayment $23.51 (range $15.02 – $45.84)

Most-billed visit code 99203

Established Patient

$74.80 typical visit price

range $18.97 – $148.12

Typical copayment $18.70 (range $4.74 – $37.03)

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 12

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

LYNDSAY ANN KANDI MD

Plastic Surgery