NPIMap

Individual provider Active NPI

Greg E Wiegand, PA-C

  • Physician Assistant
  • Wadena, MN
National Provider Identifier
1134464324
Registry record updated Oct 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
11286 Issued in MN
Practice address
415 Jefferson St North
Tri-County Hospital
Wadena, MN 56482-1296
Phone
(218) 631-3510
Fax
(218) 631-7507
NPI assigned
Nov 29, 2012
Last updated
Oct 13, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1846 MN
Physician Assistant 363A00000X 11286 MN Primary

Addresses

Primary practice location

415 Jefferson St North
Tri-County Hospital
Wadena, MN 56482-1296

Mailing address

415 Jefferson St North
Tri-County Hospital
Wadena, MN 56482-1296
Phone (218) 631-3510

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130212000462 MN Practitioner - Physician Assistant 3577717958 Reassigns benefits to 1 organization
I20260401003606 WY Practitioner - Physician Assistant 3577717958 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

501 S Burma Ave
Gillette, WY 82716-3426

PO Box
Suite 3011
Gillette, WY 82717

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.78 of 100Reported as apm
Quality
80.38
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1846MNMDAcupuncturist
1245SDMDPhysical Therapist
11286MNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Monument Health Network, Inc. CurrentSince Jun 2, 2020 Accepting new patients
Mille Lacs Health System CurrentSince Aug 28, 2017 Accepting new patients
Monument Health Network, Inc. CurrentSince Jun 2, 2020 Accepting new patients
Mille Lacs Health System CurrentSince Aug 28, 2017 Accepting new patients

Locations

200 Elm St N
Onamia, MN 56359
Phone (320) 532-2750

61 Charles St
Deadwood, SD 57732
Phone (605) 717-6000

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1354147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476316800000",
    "number": "1134464324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 JEFFERSON ST NORTH",
            "address_2": "TRI-COUNTY HOSPITAL",
            "city": "WADENA",
            "state": "MN",
            "postal_code": "564821296",
            "telephone_number": "218-631-3510",
            "fax_number": "218-631-7507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 JEFFERSON ST NORTH",
            "address_2": "TRI-COUNTY HOSPITAL",
            "city": "WADENA",
            "state": "MN",
            "postal_code": "564821296",
            "telephone_number": "218-631-3510",
            "fax_number": "218-631-7507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIEGAND",
        "first_name": "GREG",
        "middle_name": "E",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-11-29",
        "last_updated": "2016-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "1846",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "11286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wadena, MN

Sources for this page

Verify at the official NPI Registry.