Individual provider Active NPI

Grace Wettengel, PA-C

  • Physician Assistant
  • Fresno, CA
National Provider Identifier
1164193322
Registry record updated Jan 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1630 E Herndon Ave
Fresno, CA 93720-3391
Phone
(402) 630-6316
NPI assigned
Sep 27, 2021
Last updated
Jan 5, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

1630 E Herndon Ave
Fresno, CA 93720-3391

Mailing address

101 Woodcliff Cir
Council Bluffs, IA 51503-4288
Phone (402) 630-6316

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, CA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20211105000788 FL Practitioner - Physician Assistant 8022407469 Reassigns benefits to 1 organization
I20230206001680 CA Practitioner - Physician Assistant 8022407469 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1303 E Herndon Ave
Fresno, CA 93720-3309
Phone (559) 450-3000

1630 E Herndon Ave
Fresno, CA 93720-3391
Phone (559) 290-7051

2335 E Kashian LN
Fresno, CA 93701-2234

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.41 of 100Reported as group
Quality
87.02
Promoting interoperability
100
Improvement activities
40
Cost
78.21

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Community Foundation Medical Group CurrentSince Dec 7, 2022 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Nov 3, 2021 Accepting new patients
Community Foundation Medical Group CurrentSince Dec 7, 2022 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Nov 3, 2021 Accepting new patients

Locations

1630 E Herndon Ave
Fresno, CA 93720
Phone (559) 256-5200

2335 E Kashian Ln
Ste 270
Fresno, CA 93701
Phone (559) 445-1251

1600 SW Archer Rd
Gainesville, FL 32610
Phone (352) 265-0077

2001 SW 13th St
Gainesville, FL 32608
Phone (352) 265-8990

Interoperability endpoints

  • Direct secure messaging: grace.wettengel.p1@direct.spocortho.nextgenshare.com

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 3

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": "1632700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672876800000",
    "number": "1164193322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 WOODCLIFF CIR",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515034288",
            "telephone_number": "402-630-6316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 E HERNDON AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937203391",
            "telephone_number": "402-630-6316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WETTENGEL",
        "first_name": "GRACE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-27",
        "last_updated": "2023-01-05",
        "certification_date": "2023-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.