Mark Andrew Wisner, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

CO 44052 Issued in CO

Practice address

1109 Ford St
Golden, CO 80401-1176

Phone

(303) 277-2138

NPI assigned

May 11, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Kremmling Memorial Hospital District

  • Critical Access Hospital
  • Kremmling, CO
  • NPI 1619962321

  CO

  Medicare reassignment NPD
• Kremmling Memorial Hospital District

  • Critical Access Hospital
  • Fraser, CO
  • NPI 1093546996
  NPD
• Premise Health of Colorado Medical PC

  • Family Medicine Physician
  • Golden, CO
  • NPI 1215092010

  Family Medicine

  NPD
• Catholic Health Initiatives Colorado

  • Orthopaedic Surgery Physician
  • Longmont, CO
  • NPI 1891675294
  NPD (past)

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

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739232000000",
    "number": "1083829162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 399",
            "city": "KREMMLING",
            "state": "CO",
            "postal_code": "804590399",
            "telephone_number": "970-887-5800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 FORD ST",
            "city": "GOLDEN",
            "state": "CO",
            "postal_code": "804011176",
            "telephone_number": "303-277-2138"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5330 Manhattan Cir",
            "address_2": "Suite C-2",
            "address_purpose": "LOCATION",
            "city": "Boulder",
            "state": "CO",
            "postal_code": "80303",
            "country_code": "US",
            "telephone_number": "303-543-1111",
            "fax_number": "303-543-1112",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "214 South 4th Street",
            "address_purpose": "LOCATION",
            "city": "Kremmling",
            "state": "CO",
            "postal_code": "804590399",
            "country_code": "US",
            "telephone_number": "970-887-5800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WISNER",
        "first_name": "MARK",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-11",
        "last_updated": "2025-02-11",
        "certification_date": "2025-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "CO 44052",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Willow Medical Consulting
• Catherine Wilson, NP
• Gina Sue Wilson, PHD
• Laura K Wilson, AUD
• Keri Windels, PT
• Bradford J. Witman, PA-C
• Andrew J Wolfe, M.D.
• Carissa Nicole Wolfe
• Megan Wollner, MS CCC-SLP
• Douglas C Wong, MD

• Family Medicine Physician in Golden, CO
• Providers in Golden, CO by specialty
• Family Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.