NPIMap

Individual provider Active NPI

Jonathan T Wiseman, DO

  • Family Medicine Physician
  • Riverside, NJ
National Provider Identifier
1063548154
Registry record updated Mar 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25MB07242800 Issued in NJ
Practice address
129 Bridgeboro St
Riverside, NJ 08075-3201
Phone
(856) 461-0766
Fax
(856) 461-7095
NPI assigned
Feb 26, 2007
Last updated
Mar 2, 2015By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 2, 2015

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 25MB07242800 NJ Primary

Addresses

Primary practice location

129 Bridgeboro St
Riverside, NJ 08075-3201

Mailing address

129 Bridgeboro St
Riverside, NJ 08075-3201
Phone (856) 461-0766

Other identifiers 1

IdentifierTypeStateIssuer
2688905MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20110119000927 NJ Practitioner - Family PracticePractitioner - Internal Medicine 9931388287 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Internal Medicine
Education
Philadelphia College of Osteopathic Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

129 Bridgeboro St
Riverside, NJ 08075-3201
Phone (856) 761-0766

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
34.8 of 100Reported as individual
Quality
20
Improvement activities
0
Cost
89.33

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Jonathan T Wiseman DO PA Family Medicine CurrentSince Jan 19, 2011 Accepting new patients
Virtua Willingboro Hospital Inc Past Accepting new patients
Virtua - Memorial Hospital Burlington County, Inc. Past Accepting new patients
The Cooper Health System Past Accepting new patients

Locations

129 Bridgeboro St
Riverside, NJ 08075
Phone (856) 461-0766

Interoperability endpoints

  • FHIR API: https://epicproxy.et1017.epichosted.com/FHIRProxy/api/FHIR/R4

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1172448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425254400000",
    "number": "1063548154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 BRIDGEBORO ST",
            "city": "RIVERSIDE",
            "state": "NJ",
            "postal_code": "080753201",
            "telephone_number": "856-461-0766",
            "fax_number": "856-461-7095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 BRIDGEBORO ST",
            "city": "RIVERSIDE",
            "state": "NJ",
            "postal_code": "080753201",
            "telephone_number": "856-461-0766",
            "fax_number": "856-461-7095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISEMAN",
        "first_name": "JONATHAN",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-26",
        "last_updated": "2015-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MB07242800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2688905",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, NJ

Sources for this page

Verify at the official NPI Registry.