Individual provider Active NPI

Brandon Mark Wiley, M.D.

  • Cardiovascular Disease Physician
  • Los Angeles, CA
National Provider Identifier
1104152412
Registry record updated Dec 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
A116066 Issued in CA
Practice address
1520 San Pablo St Ste 1000
Los Angeles, CA 90033-5312
Phone
(323) 442-5100
NPI assigned
Oct 20, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A116066 CA
Critical Care Medicine (Internal Medicine) Physician 207RC0200X A116066 CA
Cardiovascular Disease Physician 207RC0000X A116066 CA Primary

Addresses

Primary practice location

1520 San Pablo St Ste 1000
Los Angeles, CA 90033-5312

Mailing address

PO Box 31309
Los Angeles, CA 90031-0309
Phone (323) 442-5100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, CA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20160805002306 MN Practitioner - Internal MedicinePractitioner - Cardiovascular Disease (Cardiology) 7113211640 Reassigns benefits to 1 organization
I20220912002882 CA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Critical Care (Intensivists)Practitioner - Internal Medicine 7113211640 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Critical Care (Intensivists), Internal Medicine
Education
Temple University School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Usc Care Medical Group IncGroup PAC ID 0446157747, 1,378 clinicians

Practice addresses (Care Compare)

1441 Eastlake Ave
Suite 2424
Los Angeles, CA 90089-0112
Phone (323) 442-2582

1500 San Pablo St
Los Angeles, CA 90033-5313
Phone (323) 442-8444

1516 San Pablo St
Los Angeles, CA 90033-5313
Phone (800) 872-2273

1520 San Pablo St
Los Angeles, CA 90033-5310
Phone (800) 872-2273

1520 San Pablo St 1St Floor N
Los Angeles, CA 90033-5310
Phone (800) 872-2273

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Minneapolis Heart Institute at Ridgeview Heart Center, LLC Internal Medicine CurrentSince Jan 1, 2020 Accepting new patients
Usc Care Medical Group, Inc CurrentSince Aug 1, 2022 Accepting new patients
Usc Care Medical Group, Inc Internal Medicine CurrentSince Aug 1, 2022 Accepting new patients
Mayo Clinic Health System-Lake City Past Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region Past Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region Past Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region Past Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region Past Accepting new patients
Mayo Clinic Hospital-Rochester Past Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region Past Accepting new patients
Mayo Clinic Health System-Fairmont Past Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region Past Accepting new patients
Mayo Clinic Health System-St James Past Accepting new patients

Locations

420 34th St
Bakersfield, CA 93301
Phone (661) 324-4647

1520 San Pablo St
Los Angeles, CA 90033
Phone (323) 442-5849

1520 San Pablo St
Ste 1000
Los Angeles, CA 90033
Phone (626) 457-5839

800 E 28th St
Ste H2100
Minneapolis, MN 55407
Phone (612) 863-3900

800 E 28th St
Minneapolis, MN 55407
Phone (612) 863-3547

424 W State Highway 5
Waconia, MN 55387
Phone (952) 442-4461

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 3

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": "1255996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703116800000",
    "number": "1104152412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31309",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900310309",
            "telephone_number": "323-442-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 SAN PABLO ST STE 1000",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900335312",
            "telephone_number": "323-442-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILEY",
        "first_name": "BRANDON",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-10-20",
        "last_updated": "2023-12-21",
        "certification_date": "2023-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A116066",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "CA",
            "license": "A116066",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": "A116066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.