Fredrick C Wittleder, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Practice address

5803 Neal Ave N
Oak Park Heights, MN 55082-2177

Phone

(651) 439-8807

Fax

(651) 439-0232

NPI assigned

May 14, 2012

Last updated

Oct 30, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

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 1

Specialty

Physician Assistant

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Catholic Health Initiatives ColoradoGroup PAC ID 8022927342, 1,230 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Holy Cross Hospital-Jordan Valley Hospital, West Jordan, UT, CCN 460051

Merit-based Incentive Payment System (MIPS)

Final score

89.06 of 100Reported as group

Quality

89.53

Promoting interoperability

100

Improvement activities

40

Cost

74

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: familylifecenter.fredrickwittleder@160089.advancedmd-direct.com
• Direct secure messaging: fredrick.wittleder@319.chartlogic.direct-ci.com

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.

• Catholic Health Initiatives Colorado

  dba Behavioral Health West Valley

  • Prescribing (Medical) Psychologist
  • West Valley City, UT
  • NPI 1942903562
  Medicare reassignment Care Compare group
• Catholic Health Initiatives Colorado

  dba CommonSpirit Primary Care Davis

  • Family Medicine Physician
  • Layton, UT
  • NPI 1760203293
  NPD
• Catholic Health Initiatives Colorado

  dba CommonSpirit Orthopedics Longmont

  • Orthopaedic Surgery Physician
  • Longmont, CO
  • NPI 1891675294
  NPD
• Basic Home Infusion, LLC

  dba Basic Home Infusion

  • Home Infusion Therapy Pharmacy
  • Wayne, NJ
  • NPI 1679514509
  NPD (past)
• Catholic Health Initiatives Colorado

  dba NSSH Neurosurg Sah

  • Neurological Surgery Physician
  • Lakewood, CO
  • NPI 1205846664
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Catholic Health Initiatives Colorado

  dba Holy Cross Hospital - Jordan Valley

  • General Acute Care Hospital
  • West Jordan, UT
  • NPI 1801591391
  Care Compare affiliation

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

{
    "created_epoch": "1336953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698624000000",
    "number": "1205195088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4465 S 900 E",
            "address_2": "STE 275",
            "city": "MILLCREEK",
            "state": "UT",
            "postal_code": "841242644",
            "telephone_number": "651-439-8807",
            "fax_number": "651-439-0232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5803 NEAL AVE N",
            "city": "OAK PARK HEIGHTS",
            "state": "MN",
            "postal_code": "550822177",
            "telephone_number": "651-439-8807",
            "fax_number": "651-439-0232"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3000 N Triumph Blvd Ste 110",
            "address_purpose": "LOCATION",
            "city": "Lehi",
            "state": "UT",
            "postal_code": "840437186",
            "country_code": "US",
            "telephone_number": "385-345-3555",
            "fax_number": "385-345-3554",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WITTLEDER",
        "first_name": "FREDRICK",
        "middle_name": "C",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-14",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "UT",
            "license": "10749979-1206",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wal-Mart Stores, Inc. (Vision Center 30-1861)
• Walgreen Co (Walgreens #06916)
• Walmart Inc. (Walmart Pharmacy 10-1861)
• Douglas G Weiher, D.D.S.
• Nicholas Gregory Weiss, MD
• Katherine Anne Wolden, PAC

• Surgical Physician Assistant in Oak Park Heights, MN
• Providers in Oak Park Heights, MN by specialty
• Surgical Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.