NPIMap

Individual provider Active NPI

Chandra K Wiewel, M.D.

  • Family Medicine Physician
  • O'Fallon, MO
National Provider Identifier
1033170741
Registry record updated Nov 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2005014704 Issued in MO
Practice address
1101 Highway K
O Fallon, MO 63366-8431
Phone
(636) 379-4590
Fax
(636) 669-2401
NPI assigned
Mar 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2005014704 MO Primary

Addresses

Primary practice location

1101 Highway K
O Fallon, MO 63366-8431

Mailing address

PO Box 955534
Saint Louis, MO 63195-5534

Other identifiers 1

IdentifierTypeStateIssuer
207454307MedicaidMO

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/ Other
Direct Messaging Address cwiewel6088@direct-ehr-ssmhc.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051027000049 MO Practitioner - Family Practice 4587562061 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Loyola University of Chicago, Stritch School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SSM Medical Group IncGroup PAC ID 6608776299, 565 clinicians
Aging Well Health Care, LLCGroup PAC ID 1153232038, 236 clinicians

Practice addresses (Care Compare)

1101 Hwy K
O Fallon, MO 63366-8431
Phone (636) 379-6363

7212 Balson Ave
Saint Louis, MO 63130-3001

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2005014704MOMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Medical Group, Inc. CurrentSince Aug 1, 2018 Accepting new patients
Midwest Emergency Management, Inc. Past Accepting new patients
SSM Health Care St. Louis Past Accepting new patients

Locations

1101 Highway K
O Fallon, MO 63366
Phone (636) 379-6347

1035 Bellevue Ave
Ste 500
Saint Louis, MO 63117
Phone (314) 647-1115

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 4

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": "1143763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606176000000",
    "number": "1033170741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 955534",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631955534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 HIGHWAY K",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633668431",
            "telephone_number": "636-379-4590",
            "fax_number": "636-669-2401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIEWEL",
        "first_name": "CHANDRA",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-31",
        "last_updated": "2020-11-24",
        "certification_date": "2020-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2005014704",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207454307",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1101 Highway K",
            "city": "O Fallon",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633668431",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cwiewel6088@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "cwiewel6088@direct-ehr-ssmhc.com",
            "address_1": "1101 Highway K",
            "city": "O Fallon",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633668431",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in O'Fallon, MO

Sources for this page

Verify at the official NPI Registry.