Active NPI
Irvin Michael Wiesman, MD
- Plastic Surgery Physician
- Chicago, IL
National Provider Identifier
1194897587
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- License
- 036095961
- Practice address
- 712 N Dearborn St
Chicago, IL 60654-3818 - Phone
- (312) 981-1290
- Fax
- (312) 981-1292
- NPI assigned
- Nov 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | 036095961 | IL | Primary |
Addresses
Primary practice location
712 N Dearborn St
Chicago, IL 60654-3818
Mailing address
712 N Dearborn St
Chicago, IL 60654-3818
Phone (312) 981-1290
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036095961 | Medicaid | IL | |
| 01633365 | Other | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2018 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036095961 | IL | MD | Plastic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Diversey Medical Center SC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Cardiovascular Disease Physician
- Chicago, IL
- NPI 1720096969
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433980800000",
"number": "1194897587",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "712 N DEARBORN ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606543818",
"telephone_number": "312-981-1290",
"fax_number": "312-981-1292"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "712 N DEARBORN ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606543818",
"telephone_number": "312-981-1290",
"fax_number": "312-981-1292"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIESMAN",
"first_name": "IRVIN",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-14",
"last_updated": "2015-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "IL",
"license": "036095961",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036095961",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "01633365",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2015; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.