Active NPI
Michelle Elise Wiese, MD
- Psychiatry Physician
- Fort Wayne, IN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 01093232A
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003348343 | Medicaid | WA |
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
Enrollment records 1
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
Practice addresses (Care Compare)
1720 Beacon St
Fort Wayne, IN 46805-4749
Phone (260) 373-8000
Hospital & facility affiliations
- Parkview Regional Medical Center
- Parkview Dekalb Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 93.85 of 100
- Quality
- 74.6
- Promoting interoperability
- 100
- Improvement activities
- 40
Merit-based Incentive Payment System (MIPS)
- Final score
- 83.53 of 100
- 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
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Park Center Inc | Current | Accepting new patients | |
| Parkview Health System, Inc. | Current | Accepting new patients | |
| Parkview Health System Inc | Current | Accepting new patients | |
| Park Center Inc | Current | 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
- 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.
-
- Family Medicine Physician
- Fort Wayne, IN
- NPI 1932130952
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Fort Wayne, IN
- NPI 1306897004
-
- Psychiatric Hospital
- Fort Wayne, IN
- NPI 1457772402
-
- Internal Medicine Physician
- Fort Wayne, IN
- NPI 1952411233
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Auburn, IN
- NPI 1902897937
-
- General Acute Care Hospital
- Fort Wayne, IN
- NPI 1366407603
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.