Shane Robert Wortman, DPM is a medicare enrolled "Podiatrist - Foot & Ankle Surgery" provider in Fort Campbell, Kentucky. His current practice location is
650 Joel Dr, Fort Campbell, Kentucky. You can reach out to his office (for appointments etc.) via phone at
(270) 798-8375.
Shane Robert Wortman is licensed to practice in Nebraska (license number 285) 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 1245417385.
Healthcare Provider's Profile
| Full Name | Shane Robert Wortman |
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| Gender | Male |
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| Speciality | Podiatrist - Foot & Ankle Surgery |
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| Location | 650 Joel Dr, Fort Campbell, Kentucky |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1245417385
- Provider Enumeration Date: 01/30/2008
- Last Update Date: 02/04/2019
Medicare PECOS Information:
- PECOS PAC ID: 0042539439
- Enrollment ID: I20230920000468
Medical Identifiers
Medical identifiers for Shane Robert Wortman such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1245417385 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 213ES0103X | Podiatrist - Foot & Ankle Surgery | 285 (Nebraska) | 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. Shane Robert Wortman allows following entities to bill medicare on his behalf.
| Provider Name | Gateway Foot And Ankle Center Plc |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1932335551
PECOS PAC ID: 4284771114
Enrollment ID: O20091027000272 |
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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. Shane Robert Wortman 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 |
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Shane Robert Wortman, DPM
650 Joel Drive, Podiatry/ortho Dept,
Fort Campbell, KY 42223-5318
Ph: (270) 798-8325 | Shane Robert Wortman, DPM
650 Joel Dr,
Fort Campbell, KY 42223-5318
Ph: (270) 798-8375 |
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