NPIMap

Individual provider Active NPI

Steven John Wisniewski, M.D.

  • Internal Medicine Physician
  • Gaylord, MI
National Provider Identifier
1104851658
Registry record updated Jun 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301050548 Issued in MI
Practice address
829 N Center Ave
Suite 140
Gaylord, MI 49735-1595
Phone
(989) 731-7870
Fax
(989) 731-7837
NPI assigned
Jul 12, 2006
Sex
Male
Sole proprietor
No

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Michigan State University College of Human Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Munson Healthcare Otsego Memorial Hospital 126 clinicians

Practice addresses (Care Compare)

1996 Walden
Otsego County Memorial Hospital
Gaylord, MI 49735
Phone 51773141111

Hospital & facility affiliations

  • Munson Home Care Home health agency, Traverse City, MI, CCN 237025
  • Evergreen Home Health Home health agency, Gaylord, MI, CCN 239350
  • Hospice of Northeastern Michigan Hospice, Gaylord, MI, CCN 231536
  • Munson Healthcare Otsego Memorial Hospital Hospital, Gaylord, MI, CCN 230133
  • Charlevoix Area Hospital Hospital, Charlevoix, MI, CCN 231322
  • Munson Healthcare Grayling Hospital Hospital, Grayling, MI, CCN 230058
  • Kalkaska Memorial Health Center Hospital, Kalkaska, MI, CCN 231301
  • University of Michigan Health System Hospital, Ann Arbor, MI, CCN 230046

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

All facility ownership & control disclosures 2

Medicare enrollment files

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Munson Healthcare Otsego Memorial Hospital LtcuGaylord, MI, CCN 235006 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2024
Jan 1, 2024
Munson Healthcare Omh Medical Group Gaylord RHCGaylord, MI, CCN 238607 Rural health clinic W-2 Managing Employee Aug 2, 2004

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
I20040730000558 MI Practitioner - Internal Medicine 5294705752 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
430150548MIMDGeriatric Medicine (Internal Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Munson Healthcare Otsego Memorial Hospital Current Accepting new patients
Munson Healthcare Otsego Memorial Hospital CurrentSince Jul 1, 2004 Accepting new patients
Munson Healthcare Otsego Memorial Hospital Current Accepting new patients
Munson Healthcare Otsego Memorial Hospital Current Accepting new patients
Munson Healthcare Otsego Memorial Hospital CurrentSince Jul 1, 2004 Accepting new patients
Munson Healthcare Otsego Memorial Hospital Current Accepting new patients
Munson Healthcare Otsego Memorial Hospital Past Accepting new patients

Locations

829 N Center Ave
Ste 140
Gaylord, MI 49735
Phone (989) 731-7860

829 N Center Ave
Gaylord, MI 49735
Phone (989) 731-2100

Interoperability endpoints

  • Direct secure messaging: swisniewski@direct.mhc.net

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 430150548 MI
Internal Medicine Physician 207R00000X 4301050548 MI Primary

Addresses

NPPES NPI Registry

Primary practice location

829 N Center Ave
Suite 140
Gaylord, MI 49735-1595

Mailing address

271 McCoy Rd W
Gaylord, MI 49735-8253
Phone (989) 731-7708

Other identifiers 6

NPPES NPI Registry
IdentifierTypeStateIssuer
381303843OtherTAX ID
4619513MedicaidMI
11292239OtherCAQH PROVIDER ID
0F96004016OtherMIMEDICARE PTAN
1101507782OtherMIBCBSM PROVIDER NUMBER
CC4805OtherMEDICARE RR PROV ID

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 19, 2018.

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529366400000",
    "number": "1104851658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "271 MCCOY RD W",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497358253",
            "telephone_number": "989-731-7708",
            "fax_number": "989-731-7929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "829 N CENTER AVE",
            "address_2": "SUITE 140",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497351595",
            "telephone_number": "989-731-7870",
            "fax_number": "989-731-7837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISNIEWSKI",
        "first_name": "STEVEN",
        "middle_name": "JOHN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2018-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "MI",
            "license": "430150548",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301050548",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "381303843",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4619513",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH PROVIDER ID",
            "identifier": "11292239",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "0F96004016",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM PROVIDER NUMBER",
            "identifier": "1101507782",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR PROV ID",
            "identifier": "CC4805",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gaylord, MI

Sources for this page

Verify at the official NPI Registry.