Individual provider Active NPI

Michelle Elise Wiese, MD

  • Psychiatry Physician
  • Fort Wayne, IN
National Provider Identifier
1003348343
Registry record updated Jun 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
01093232A Issued in IN
Practice address
909 E State Blvd
Fort Wayne, IN 46805-3404
Phone
(260) 481-2700
Fax
(260) 481-2838
NPI assigned
Mar 28, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X MD60988236 WA
Psychiatry Physician 2084P0800X 01093232A IN Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

909 E State Blvd
Fort Wayne, IN 46805-3404

Mailing address

11109 Parkview Plaza Dr # 117
Fort Wayne, IN 46845-1701

Other practice location 1

1720 Beacon St
Fort Wayne, IN 46805-4749
Phone (260) 373-8000

Other identifiers 1

IdentifierTypeStateIssuer
1003348343MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240723003449 IN Practitioner - Psychiatry 1456629435 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of Nebraska College of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Parkview Health System IncGroup PAC ID 2163336967, 1,350 clinicians

Practice addresses (Care Compare)

1720 Beacon St
Fort Wayne, IN 46805-4749
Phone (260) 373-8000

Hospital & facility affiliations

  • Parkview Regional Medical Center Hospital, Fort Wayne, IN, CCN 150021
  • Parkview Dekalb Hospital Hospital, Auburn, IN, CCN 150045

Merit-based Incentive Payment System (MIPS)

Final score
93.85 of 100Reported as apm
Quality
74.6
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
83.53 of 100Reported as group
Quality
70
Promoting interoperability
100
Improvement activities
40
Cost
75.11

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Park Center Inc CurrentSince Jul 16, 2024 Accepting new patients
Parkview Health System, Inc. CurrentSince Jul 16, 2024 Accepting new patients
Parkview Health System Inc Current Accepting new patients
Park Center Inc CurrentSince Jul 16, 2024 Accepting new patients

Locations

11109 Parkview Plaza Dr
#117
Fort Wayne, IN 46845
Phone (260) 266-6012

1909 Carew St
Fort Wayne, IN 46805
Phone (260) 481-2800

909 E State Blvd
Fort Wayne, IN 46805
Phone (260) 481-2718

1720 Beacon St
Fort Wayne, IN 46805
Phone (260) 373-7500

240 S Jefferson St
Ste B
Huntington, IN 46750
Phone (219) 259-0000

512 Professional Way
Kendallville, IN 46755
Phone (260) 347-8556

Networks

  • OH PPO
  • devoted network organization-598bd2d4-c652-473f-ba7a-132f674c8eb6
  • KY PPO C-SNP
  • KY PPO
  • IL PPO Downstate
  • devoted network organization-1baeae7e-6b6f-49f9-a562-1b2d2e55c806
  • IL HMO C-SNP

Interoperability endpoints

  • Direct secure messaging: mwiese654418@direct.parkviewexchange.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719532800000",
    "number": "1003348343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11109 PARKVIEW PLAZA DR # 117",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 E STATE BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468053404",
            "telephone_number": "260-481-2700",
            "fax_number": "260-481-2838"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1720 Beacon St",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468054749",
            "country_code": "US",
            "telephone_number": "260-373-8000",
            "fax_number": "260-373-8034",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIESE",
        "first_name": "MICHELLE",
        "middle_name": "ELISE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-28",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WA",
            "license": "MD60988236",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "01093232A",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003348343",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.