Jake T Wysiadlowski

Primary specialty

OptometristTaxonomy code 152W00000X

License

3768 Issued in TN

Practice address

1801 W End Ave Ste 1150
Nashville, TN 37203-2528

Phone

(615) 321-8881

Fax

(615) 321-8874

NPI assigned

Aug 25, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wang Vision Institute, PLLCGroup PAC ID 4183775125, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jwysiad@wangvisioninstitute.imwdirect.com
• FHIR API: https://app.meldrx.com/api/fhir/imedicware_wang_vision

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.

• Wang Vision Institute, PLLC

  • Ophthalmology Physician
  • Nashville, TN
  • NPI 1154445591
  Medicare reassignment Care Compare group NPD
• Dell Laser Consultants

  • Ophthalmologic Surgery Clinic/Center
  • Austin, TX
  • NPI 1316347339
  NPD (past)
• Dell Laser Consultants, P.a.

  • Ophthalmology Physician
  • Austin, TX
  • NPI 1386164481
  NPD (past)

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

{
    "created_epoch": "1629849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664409600000",
    "number": "1255008462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 W END AVE STE 1150",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372032528",
            "telephone_number": "615-321-8881",
            "fax_number": "615-321-8881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 W END AVE STE 1150",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372032528",
            "telephone_number": "615-321-8881",
            "fax_number": "615-321-8874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYSIADLOWSKI",
        "first_name": "JAKE",
        "middle_name": "T",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-25",
        "last_updated": "2022-09-29",
        "certification_date": "2022-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "10378",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "3768",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Raelonda M Wynn, LCSW
• Amber Wynne, RN
• Georgia Wynne
• Alison Regina Wynns, CRNA
• Ashley Ann Wyse, N.P.
• Allie Rose Wysong, APRN
• Thomas Wywrot, COTA/L
• X Ray Services Inc
• X Ray Services, Inc.
• Xanadu Healthcare, LLC

• Optometrist in Nashville, TN
• Providers in Nashville, TN by specialty
• Optometrist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2022; 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.