Mark L Wiesner, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

31069 Issued in CO

Practice address

122 Stanley Circle Dr
Estes Park, CO 80517-6302

Phone

(970) 685-1148

NPI assigned

Nov 25, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in CO

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Poudre Valley Medical Group, LLC

  dba UCHealth Medical Group

  • General Practice Physician
  • Loveland, CO
  • NPI 1225356868
  Medicare reassignment NPD
• Poudre Valley Medical Group, LLC

  dba UCHealth Medical Group

  • General Practice Physician
  • Loveland, CO
  • NPI 1366763260
  NPD
• Big Thompson Medical Group Inc

  • Family Medicine Physician
  • Loveland, CO
  • NPI 1720011786

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1132876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780358400000",
    "number": "1154304939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 STANLEY CIRCLE DR",
            "city": "ESTES PARK",
            "state": "CO",
            "postal_code": "805176302",
            "telephone_number": "970-685-1148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 STANLEY CIRCLE DR",
            "city": "ESTES PARK",
            "state": "CO",
            "postal_code": "805176302",
            "telephone_number": "970-685-1148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIESNER",
        "first_name": "MARK",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-25",
        "last_updated": "2026-06-02",
        "certification_date": "2026-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CO",
            "license": "31069",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0725614",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "WIA4011",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01310697",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107825900",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "841287602",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Walde, PT, DPT
• Eliska C Webster, PA-C
• Curtis P Weibel, F.N.P.-C
• Wellness Way Estes Park LLC
• Wellspring Group
• Brenda S. Wilkerson, LCSW, CAC III
• Scott D Woodard, MD
• Bruce Alan Woolman, D.O.
• Workman Hearing & Balance Inc. (Community Hearing Center)
• Cory Workman, AU.D.

• Pediatrics Physician in Estes Park, CO
• Providers in Estes Park, CO by specialty
• Pediatrics Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2026; 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.