NPIMap

Individual provider Active NPI

Kevin M Wiesmann, M.D.

  • Diagnostic Radiology Physician
  • Portland, OR
National Provider Identifier
1164401535
Registry record updated Feb 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
170867 Issued in OR
Practice address
9205 SW Barnes Rd
Portland, OR 97225-6603
Phone
(503) 216-4830
NPI assigned
Jan 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 47145 MN
Diagnostic Radiology Physician 2085R0202X 25.000136 OH
Diagnostic Radiology Physician 2085R0202X 170867 OR Primary

Addresses

Primary practice location

9205 SW Barnes Rd
Portland, OR 97225-6603

Mailing address

PO Box 25180
Portland, OR 97298-0180
Phone (503) 797-6356

Other identifiers 1

IdentifierTypeStateIssuer
679483100MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI, OR2 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
I20100107000730 HI Practitioner - Diagnostic Radiology 6709865801 Reassigns benefits to 1 organization
I20170105001131 OR Practitioner - Diagnostic Radiology 6709865801 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Center for Medical Imaging LLCGroup PAC ID 9335191543, 28 clinicians
Bridgeport Medical Imaging, LLCGroup PAC ID 3173670411, 28 clinicians
TRG, LLCGroup PAC ID 8820283617, 35 clinicians

Practice addresses (Care Compare)

10810 NE Cornell Rd
Suite 100
Hillsboro, OR 97124-9219
Phone (503) 216-8400

18040 Swlower Boones Ferry Rd
Suite 106
Tigard, OR 97224-7259
Phone (503) 216-8400

7305 SE Circuit Dr
Suite 170
Hillsboro, OR 97123-1915
Phone (503) 216-8400

9205 SW Barnes Rd
Portland, OR 97225-6603
Phone (503) 216-4830

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25.000136OHMDDiagnostic Radiology Physician
170867ORMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Oregon CurrentSince Jan 13, 2017 Accepting new patients
Bridgeport Medical Imaging, LLC Diagnostic Radiology CurrentSince Jan 9, 2017 Accepting new patients
Providence Health & Services - Oregon Current Accepting new patients
Providence Health & Services Oregon CurrentSince Jan 13, 2017 Accepting new patients
Providence Health & Services - Oregon CurrentSince Jan 13, 2017 Accepting new patients
Providence Health & Services - Oregon CurrentSince Jan 13, 2017 Accepting new patients
Providence Health & Services - Oregon CurrentSince Jan 13, 2017 Accepting new patients
Center for Medical Imaging LLC Diagnostic Radiology CurrentSince Jan 9, 2017 Accepting new patients
Clinic Medical Services Company LLC Diagnostic Radiology CurrentSince Aug 3, 2009 Accepting new patients
TRG, LLC Diagnostic Radiology CurrentSince Jan 9, 2017 Accepting new patients
Clinic Medical Services Company Diagnostic Radiology CurrentSince Aug 3, 2009 Accepting new patients
Providence Health & Services Oregon Current Accepting new patients

Locations

67-1125 Mamalahoa Hwy
Kamuela, HI 96743
Phone (808) 881-4400

9500 Euclid Ave
Cleveland, OH 44195
Phone (216) 442-1270

1740 Cleveland Rd
Wooster, OH 44691
Phone (330) 287-4500

10810 NE Cornell Rd
Ste 100
Hillsboro, OR 97124
Phone (503) 216-4399

1001 N Providence Dr
Newberg, OR 97132
Phone (503) 216-1538

9205 SW Barnes Rd
Portland, OR 97225
Phone (503) 216-1234

725 S Wahanna Rd
Seaside, OR 97138
Phone (503) 717-7000

18040 SW Lower Boones Ferry Rd
Ste 106
Tigard, OR 97224
Phone (503) 216-8400

Organizations & group practices 12

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 6

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": "1137024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486512000000",
    "number": "1164401535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25180",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972980180",
            "telephone_number": "503-797-6356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9205 SW BARNES RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256603",
            "telephone_number": "503-216-4830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIESMANN",
        "first_name": "KEVIN",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-12",
        "last_updated": "2017-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MN",
            "license": "47145",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OH",
            "license": "25.000136",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OR",
            "license": "170867",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "679483100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.