Ava Marie Wiedemann, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA57411 Issued in CA

Practice address

9665 Chesapeake Dr Ste 350
San Diego, CA 92123-1352

Phone

(877) 260-2261

NPI assigned

Oct 23, 2019

Sex

Female

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 CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: awiedemann@landmarkhealth-direct.org

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.

• Concertocare Medical Group of California, P.C.

  • Internal Medicine Physician
  • Huntington Beach, CA
  • NPI 1922777259
  Medicare reassignment

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

{
    "created_epoch": "1571788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573171200000",
    "number": "1104469055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2131 E GRETTA PL",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850223436",
            "telephone_number": "602-793-6456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9665 CHESAPEAKE DR STE 350",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921231352",
            "telephone_number": "877-260-2261"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2101 Rosecrans Ave # 3230",
            "address_purpose": "LOCATION",
            "city": "El Segundo",
            "state": "CA",
            "postal_code": "902454749",
            "country_code": "US",
            "telephone_number": "323-628-8671",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIEDEMANN",
        "first_name": "AVA",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-23",
        "last_updated": "2019-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA57411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Widjaja
• Tehya Jas Widmann
• Alyssa Wieand
• Abigail Leigh Wieck
• Jennifer Wiecks, AU.D.
• Marilyn A Wiedemann
• Mark D Wiederhold, M.D.
• Ciara Mairghread Wiegand, DACM, LAC
• Sarah Elizabeth Wiegand, DO
• Janice Wiegman, RD

• Physician Assistant in San Diego, CA
• Providers in San Diego, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2019; 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.