NPIMap

Individual provider Active NPI

David Paul Wise, MD, DDS

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Charleston, WV
National Provider Identifier
1154385185
Registry record updated Jun 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X
License
18520 Issued in WV
Practice address
415 Morris St Ste 309
Charleston, WV 25301-1853
Phone
(304) 388-3290
Fax
(304) 388-3186
NPI assigned
Apr 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X 18520 WV Primary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 3328 WV

Addresses

Primary practice location

415 Morris St Ste 309
Charleston, WV 25301-1853

Mailing address

415 Morris St Suite 309
Charleston, WV 25301-1953
Phone (304) 388-3290

Other practice location 1

1220 Lee St E
Charleston, WV 25301-1863
Phone (304) 388-1800

Other practice location 2

3200 MacCorkle Ave SE
Charleston, WV 25304-1297
Phone (304) 388-5432

Other practice location 3

830 Pennsylvania Ave Ste 302
Charleston, WV 25302-3390
Phone (304) 388-5950

Other practice location 4

800 Pennsylvania Ave
Charleston, WV 25302-3351
Phone (304) 388-5432

Other practice location 5

501 Morris St
Charleston, WV 25301-1326
Phone (304) 647-6006

Other identifiers 3

IdentifierTypeStateIssuer
0047377-001MedicaidWV
0047377000MedicaidWV
850000198OtherRAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080108000449 WV Practitioner - Maxillofacial SurgeryPractitioner - Oral Surgery 6406936129 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Maxillofacial SurgeryAlso: Oral Surgery
Education
University of Nebraska College of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

501 Morris St
Charleston, WV 25301-1326
Phone (304) 388-7823

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.94 of 100Reported as apm
Quality
69.71
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3328WVMDOral and Maxillofacial Surgery (Dentist)

Practice roles

OrganizationSpecialtyStatusNew patients
Charleston Area Medical Center Inc CurrentSince Dec 1, 2015 Accepting new patients
Charleston Area Medical Center, Inc. Current Accepting new patients
Charleston Area Medical Center Inc Past Accepting new patients

Locations

800 Pennsylvania Ave
Charleston, WV 25302
Phone (304) 388-2550

415 Morris St
Ste 104
Charleston, WV 25301
Phone (304) 343-1399

3200 Maccorkle Ave SE
Charleston, WV 25304
Phone (304) 388-2550

501 Morris St
Charleston, WV 25301
Phone (304) 348-6293

3100 Maccorkle Ave SE
Ste 203
Charleston, WV 25304
Phone (304) 345-8820

830 Pennsylvania Ave
Ste 302
Charleston, WV 25302
Phone (304) 388-2950

415 Morris St
Ste 309
Charleston, WV 25301
Phone (304) 348-3290

3703 Teays Valley Rd
Hurricane, WV 25526
Phone (304) 757-2273

Organizations & group practices 3

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 11

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": "1144972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687219200000",
    "number": "1154385185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 MORRIS ST SUITE 309",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253011953",
            "telephone_number": "304-388-3290",
            "fax_number": "304-388-3186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 MORRIS ST STE 309",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253011853",
            "telephone_number": "304-388-3290",
            "fax_number": "304-388-3186"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1220 Lee St E",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "WV",
            "postal_code": "253011863",
            "country_code": "US",
            "telephone_number": "304-388-1800",
            "fax_number": "304-388-1825",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3200 MacCorkle Ave SE",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "WV",
            "postal_code": "253041297",
            "country_code": "US",
            "telephone_number": "304-388-5432",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "830 Pennsylvania Ave Ste 302",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "WV",
            "postal_code": "253023390",
            "country_code": "US",
            "telephone_number": "304-388-5950",
            "fax_number": "304-388-2951",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "800 Pennsylvania Ave",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "WV",
            "postal_code": "253023351",
            "country_code": "US",
            "telephone_number": "304-388-5432",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "501 Morris St",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "WV",
            "postal_code": "253011326",
            "country_code": "US",
            "telephone_number": "304-647-6006",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WISE",
        "first_name": "DAVID",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "MD, DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-14",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "WV",
            "license": "18520",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "WV",
            "license": "3328",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0047377-001",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0047377000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "850000198",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

Verify at the official NPI Registry.