CMS-1500 Box 24J / 33a • NPI
1295781425
Type 1 Individual Rendering/Ordering
HIPAA NUCC Taxonomy • CMS Code
152W00000X (CMS 41)
Licensed & Credentialed Eye and Vision Service Providers — Optometrist
Box 32 Service Location & ZIP+4
30960 GOVERNMENT DR, PEQUOT LAKES, MN, 56472-1003
✓ 9-Digit EDI 837 ZIP+4 (56472-1003)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1295781425 (TODD M WIEDELL, O.D.) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Medicare Part B
✓ Eligible
DMEPOS Ordering
✓ Eligible
Home Health (HHA)
✓ Eligible
Power Mobility
No
Hospice Referring
✓ Eligible
Empirical CMS Medicare Claims, CPT Utilization & Part D Prescribing (NPI #1295781425)
Medicare Beneficiaries
192
Total Billed Services
1,780
Distinct CPT/HCPCS Codes
15
Medicare Allowed Total
$29,482.37
Actual Top Billed CPT / HCPCS Procedures (CMS Part B)
| CPT / HCPCS | Clinical Procedure Description | Services |
|---|---|---|
92004 | New patient complete exam of visual system | 25 |
92014 | Established patient complete exam of visual system | 145 |
92250 | Photography of the retina | 20 |
99212 | Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more | 21 |
99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | 31 |
Actual Top Prescribed Medications (CMS Part D)
| Brand / Generic Medication | Total Claims | Patients |
|---|---|---|
| Latanoprost Latanoprost | 88 | 23 |
| Neomycin-Polymyxin-Dexameth Neomycin/Polymyxin B/Dexametha | 14 | 11 |
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1295781425 (NPI-1 Individual Practitioner) |
|---|---|
| Provider / Legal Name | TODD M WIEDELL, O.D. |
| Plain-English Specialty | Licensed & Credentialed Eye and Vision Service Providers — Optometrist NUCC Code: 152W00000X (Optometrist) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 30960 GOVERNMENT DR, PEQUOT LAKES, MN, 56472-1003 |
| Practice Telephone / Fax | Tel: (218) 568-5555 | Fax: (218) 568-8904 |
| Administrative Mailing Address | PO BOX 176, PEQUOT LAKES, MN, 56472-0176 |
| Enumeration & Last Sync | Enumerated: 2006-05-26 | CMS Record Updated: 2019-01-21 |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (152W00000X)
What Does Taxonomy Code 152W00000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 152W00000X translates to:
"Licensed & Credentialed Eye and Vision Service Providers — Optometrist"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (TODD M WIEDELL, O.D.)
Typical CPT / Diagnostic Procedures:- Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
- Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
- Preventive Screening, Patient Counseling & Multidisciplinary Referral
- Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
152W00000X — OptometristPlain English: Licensed & Credentialed Eye and Vision Service Providers — Optometrist | State: MN | License: 2945 | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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