THERON WAISATH (DMD) – Oral and Maxillofacial Surgery (Dentist), NPI 1144423963
Oral and Maxillofacial Surgery (Dentist)
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
58 MAXILLOFACIAL SURGERY in IL
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Provider Addresses for THERON WAISATH (DMD)
Village Office Place, Village at the Crossing, Champaign, Champaign County, Illinois, 61821-5359, United States
CHAMPAIGN, IL 618227680
Phone: (217) 351-7111
Fax: (217) 351-7282
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 3 Open Payments records for all available years, with a total value of $65.
Total Amount is formed as General ($65) + Research ($0) + Ownership ($0) = $65.
Last reported payment date: 2024-12-12 • Largest payer in this snapshot: ZIMVIE INC. ($65).
Total Amount
$65
General + Research + Ownership
Payments
3
Total payment records
General Amount
$65
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-12
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ZIMVIE INC. | $65 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2011-03-24
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20110324000222 | I | Maxillofacial Surgery | IL | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 61822)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Maxillofacial Surgery | IL |
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