MISS BONNIE BETH WICKHAM (PA) – Physician Assistant, NPI 1225058902
Physician Assistant
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
8,491 PHYSICIAN ASSISTANT in TX
Provider Addresses for MISS BONNIE BETH WICKHAM (PA)
402 W 26th St
San Angelo, TX 769032826
Phone: (325) 658-1511
Fax: (325) 481-2166
Type: Location
61250 SE COOMBS PL
BEND, OR 977023704
Phone: (541) 706-5930
Fax: (541) 706-5931
Type: Location
PO BOX 22000
SAN ANGELO, TX 769027200
Phone: (325) 658-1511
Fax: (325) 481-2104
Type: Mailing
402, West 26th Street, San Angelo, Tom Green County, Texas, 76903, United States
SAN ANGELO, TX 769032826
Phone: (325) 658-1511
Fax: (325) 481-2166
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2024-11-19
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 3 Medicare enrollment records; no due dates published yet.
Enrollment records
3
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 |
|---|---|---|---|---|
| I20061010000769 | I | Physician Assistant | TX | TBD |
| I20231108001526 | I | Physician Assistant | AK | TBD |
| I20241119000290 | I | Physician Assistant | OR | 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 76903)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PHYSICIAN ASSISTANT | TX | 93010 | Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report | 27 | 26 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | OR | |
| Orthopedic Surgery | NM | |
| Family Practice | OR | |
| Nurse Practitioner | OR | |
| Hand Surgery | OR | |
| Diagnostic Radiology | OR | |
| Physician Assistant | OR | |
| Nurse Practitioner | OR | |
| - | OR | |
| General Surgery | OR |
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