NPIMap

Individual provider Active NPI

Pieter Wiersema, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Indianapolis, IN
National Provider Identifier
1083890651
Registry record updated Mar 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
01030601A Issued in IN
Practice address
8051 S Emerson Ave
Suite 200
Indianapolis, IN 46237-8632
Phone
(317) 865-2955
Fax
(317) 865-8653
NPI assigned
Jan 14, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Cytopathology Physician 207ZC0500X 01030601A IN
Dermatopathology (Pathology) Physician 207ZD0900X 01030601A IN
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 01030601A IN Primary

Addresses

Primary practice location

8051 S Emerson Ave
Suite 200
Indianapolis, IN 46237-8632

Mailing address

8051 S Emerson Ave
Suite 200
Indianapolis, IN 46237-8632
Phone (317) 865-2955

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20170130000194 IN Practitioner - Pathology 8527245034 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Medical College of Ohio, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Johnson Memorial HospitalGroup PAC ID 8527972595, 39 clinicians

Practice addresses (Care Compare)

1125 W Jefferson St
Franklin, IN 46131-2140
Phone (317) 346-3858

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01030601AINMDDermatopathology (Pathology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cytology Pathology Services Inc. Current Accepting new patients
Indianapolis Gastroenterology, LLC Anatomic Pathology & Clinical Pathology CurrentSince Oct 1, 2016 Accepting new patients
Johnson Memorial Hospital CurrentSince Mar 1, 2023 Accepting new patients
Johnson Memorial Hospital CurrentSince Mar 1, 2023 Accepting new patients

Locations

1125 W Jefferson St
Franklin, IN 46131
Phone (317) 346-3858

8051 S Emerson Ave
Ste 200
Indianapolis, IN 46237

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/1d5dc169-f536-4ee1-9c67-c93c23521729/

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": "1200268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583712000000",
    "number": "1083890651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8051 S EMERSON AVE",
            "address_2": "SUITE 200",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462378632",
            "telephone_number": "317-865-2955",
            "fax_number": "317-865-8653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8051 S EMERSON AVE",
            "address_2": "SUITE 200",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462378632",
            "telephone_number": "317-865-2955",
            "fax_number": "317-865-8653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIERSEMA",
        "first_name": "PIETER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-14",
        "last_updated": "2020-03-09",
        "certification_date": "2020-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZC0500X",
            "taxonomy_group": "",
            "desc": "Pathology, Cytopathology",
            "state": "IN",
            "license": "01030601A",
            "primary": false
        },
        {
            "code": "207ZD0900X",
            "taxonomy_group": "",
            "desc": "Pathology, Dermatopathology",
            "state": "IN",
            "license": "01030601A",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IN",
            "license": "01030601A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.