PAUL WILLIAM WALES M.D.
NPI 1154080372
Surgery - Pediatric Surgery in Cincinnati, OH
NPI Status: Active since December 15, 2021
Contact Information
3333 BURNETT AVE.
MLC
CINCINNATI, OH
ZIP 45229
Phone: (513) 803-0134
- Individual
- Male
- Surgery
- Pediatric Surgery
- Accepts Insurance
- PECOS Enrolled
About PAUL WALES
This page provides the complete NPI Profile along with additional information for Paul Wales, a provider established in Cincinnati, Ohio with a medical specialization in Surgery, focusing in pediatric surgery . The healthcare provider is registered in the NPI registry with number 1154080372 assigned on December 2021. The practitioner's primary taxonomy code is 2086S0120X with license number 35.143678 (OH). The provider is registered as an individual and his NPI record was last updated 4 years ago.
- NPI
- 1154080372
- Provider Name
- PAUL WILLIAM WALES M.D.
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 3333 BURNETT AVE. MLC CINCINNATI, OH 45229
- Location Phone
- (513) 803-0134
- Mailing Address
- 3333 BURNETT AVE. MLC CINCINNATI, OH 45229
- Mailing Phone
- (513) 803-0134
- Is Sole Proprietor?
- No
- Enumeration Date
- 12-15-2021
- Last Update Date
- 12-15-2021
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Surgery Pediatric Surgery
- Taxonomy Code
- 2086S0120X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- 35.143678
- License State
- OH
- Taxonomy Description
- A surgeon with expertise in the management of surgical conditions in premature and newborn infants, children and adolescents.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Bronze First 7500 $25 Generic Drugs - HMO
- Bronze First 7500 $25 Generic Drugs Adult Vision & Fitness - HMO
- Core Gold 1500 $10 Generic Drugs - HMO
- Core Gold 1500 $10 Generic Drugs Adult Vision & Fitness - HMO
- Diabetes Gold 1100 $0 Select Drugs & Specialized Services - HMO
- Diabetes Gold 1100 $0 Select Drugs & Specialized Services Adult Vision & Fitness - HMO
- Diabetes Silver 4000 $0 Select Drugs & Specialized Services - HMO
- Diabetes Silver 4000 $0 Select Drugs & Specialized Services Adult Vision & Fitness - HMO
- Gold 1500 $15 Generic Drugs - HMO
- Gold 1500 $15 Generic Drugs Adult Vision & Fitness - HMO
- HDHP Preventive Silver 5500 $0 Select Drugs - HMO
- Healthy Heart Gold 1500 $0 Select Drugs & Specialized Services - HMO
- Healthy Heart Gold 1500 $0 Select Drugs & Specialized Services Adult Vision & Fitness - HMO
- Healthy Heart Silver 4500 $0 Select Drugs & Specialized Services - HMO
- Healthy Heart Silver 4500 $0 Select Drugs & Specialized Services Adult Vision & Fitness - HMO
- Low Premium Silver 6000 $3 Generic Drugs - HMO
- Low Premium Silver 6000 $3 Generic Drugs Adult Vision & Fitness - HMO
- Silver 5000 $20 Generic Drugs - HMO
- Silver 5000 $20 Generic Drugs Adult Vision & Fitness - HMO
- Bronze $8,300 w/ Virtual & Wellness ON-EX - HMO
- Bronze HSA $7,300 ON-EX - HMO
- Bronze Standard w/ Virtual & Wellness - HMO
- Gold $1250 w/ Virtual & Wellness ON-EX - HMO
- Gold $500 w/ Virtual & Wellness ON-EX - HMO
- Gold Standard w/ Virtual & Wellness - HMO
- Silver $5000 w/ Virtual & Wellness ON-EX - HMO
- Silver Standard w/ Virtual & Wellness - HMO
- SilverSelect w/ Virtual & Wellness ON-EX - HMO
- Young Adult Essentials ON-EX - HMO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Medicare Participation & PECOS Enrollment Status
Paul Wales is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes
Reviews for PAUL WILLIAM WALES M.D.
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 1 | 5 | 4 | 0 | 8 | 0 | 3 | 7 | 2 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 1 | 10 | 4 | 0 | 8 | 0 | 3 | 14 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 1 + 1 + 0 + 4 + 0 + 8 + 0 + 3 + 1 + 4 + 24 = 48 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 50 - 48 = 2 | 2 | ||||||||
The NPI number 1154080372 is valid because the calculated check digit 2 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following provider is registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1841244084 | MS. CARLA J BRANSON NP/APN Individual | Nurse Practitioner (Psychiatric/Mental Health) | 3333 BURNETT AVE. CINCINNATI CHILDRENS HOSPITAL CREDENTIALING CINCINNATI, OH 45229 (317) 826-1489 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1154080372, enumerated in the NPI registry as an "individual" on December 15, 2021
The provider is located at 3333 Burnett Ave. Mlc Cincinnati, Oh 45229 and the phone number is (513) 803-0134
The provider's speciality is Surgery with taxonomy code 2086S0120X with a focus in Pediatric Surgery
The provider might be accepting Accepts: CareSource and MedMutual. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
This NPI record was last updated on December 15, 2021. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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