Domanic Wiltermood, FNP-C in West Lafayette, IN

Domanic Wiltermood, FNP-C is a medicare enrolled "Nurse Practitioner - Family" in West Lafayette, Indiana. His current practice location is 915 Sagamore Pkwy W, West Lafayette, Indiana. You can reach out to his office (for appointments etc.) via phone at (765) 463-2424.

Domanic Wiltermood is licensed to practice in Indiana (license number 71014180A) 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 1992489579.

Contact Information

	Domanic Wiltermood, FNP-C
	915 Sagamore Pkwy W, West Lafayette, IN 47906-1443
	(765) 463-2424
	Not Available

Map and Direction

Provider's Profile

Full Name	Domanic Wiltermood
Gender	Male
Speciality	Nurse Practitioner - Family
Location	915 Sagamore Pkwy W, West Lafayette, Indiana
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1992489579
Provider Enumeration Date: 06/14/2023
Last Update Date: 09/05/2023

Medicare PECOS Information:

PECOS PAC ID: 2163886334
Enrollment ID: I20230907001309

Medical Identifiers

Medical identifiers for Domanic Wiltermood such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1992489579	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
163W00000X	Registered Nurse	28225056A (Indiana)	Secondary
363LF0000X	Nurse Practitioner - Family	71014180A (Indiana)	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. Domanic Wiltermood allows following entities to bill medicare on his behalf.

Entity Name	Franciscan Physician Network
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1225327984 PECOS PAC ID: 3072790682 Enrollment ID: O20110608000486

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. Domanic Wiltermood 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
Domanic Wiltermood, FNP-C Po Box 781076, Detroit, MI 48278-1076 Ph: (317) 528-4800	Domanic Wiltermood, FNP-C 915 Sagamore Pkwy W, West Lafayette, IN 47906-1443 Ph: (765) 463-2424

Reviews and Comments

Nurse Practitioner Nurses in West Lafayette, IN

Laura L Wavra, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 124 Sagamore Pkwy W, West Lafayette, IN 47906 Phone: 765-463-6722 Fax: 765-463-0905
Marcia Ann Stroup, CRNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 253 Sagamore Pkwy W, West Lafayette, IN 47906 Phone: 765-448-8000 Fax: 765-448-8227
Mrs. Ashley Nicole Hogan, PMHNP-BC Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 502 N University St, West Lafayette, IN 47907 Phone: 317-207-7413
Gayle Doll, FNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 512 Sagamore Pkwy W, West Lafayette, IN 47906 Phone: 765-497-3551
Mrs. Stephanie L. Davitto, N.P. Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 124 Sagamore Pkwy West, West Lafayette, IN 47906 Phone: 765-463-6722 Fax: 765-463-0905
Yun Cai, Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 601 Stadium Mall Dr, West Lafayette, IN 47907 Phone: 765-494-1700
Azza H Ahmed, CPNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 502 N University St, West Lafayette, IN 47907 Phone: 765-494-4040

Domanic Wiltermood, FNP-C - Medicare Nurse Practitioner in West Lafayette, IN