NPIMap

Individual provider Active NPI

Jeffrey Mark Wiisanen, MD

  • Hematology & Oncology Physician
  • Fargo, ND
National Provider Identifier
1306282025
Registry record updated Sep 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
58264 Issued in MN
Practice address
820 4TH St N
Fargo, ND 58102-4539
Phone
(701) 234-6161
Fax
(701) 234-7592
NPI assigned
May 21, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 58264 MN
Hematology & Oncology Physician 207RH0003X 58264 MN Primary

Addresses

Primary practice location

820 4TH St N
Fargo, ND 58102-4539

Mailing address

820 4TH St N
Fargo, ND 58102-4539
Phone (701) 234-6161

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191112003141 ND Practitioner - Hematology 1658519301 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hematology
Education
University of North Dakota School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sanford Medical Center FargoGroup PAC ID 8426967803, 1,210 clinicians

Practice addresses (Care Compare)

820 4TH St N
Fargo, ND 58102-4539
Phone (701) 234-6161

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.39 of 100Reported as group
Quality
91.62
Promoting interoperability
100
Improvement activities
40
Cost
66.36

Merit-based Incentive Payment System (MIPS)

Final score
93.78 of 100Reported as apm
Quality
80.38
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
82.73 of 100Reported as group
Quality
71.75
Promoting interoperability
100
Improvement activities
40
Cost
70.68

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lutheran Charity Association CurrentSince Nov 22, 2019 Accepting new patients
Lutheran Charity Association Current Accepting new patients
Sanford Medical Center Fargo Internal Medicine CurrentSince Aug 18, 2019 Accepting new patients
Lutheran Charity Association Current Accepting new patients
Sanford Medical Center Fargo CurrentSince Aug 18, 2019 Accepting new patients
Lutheran Charity Association CurrentSince Nov 22, 2019 Accepting new patients

Locations

820 4th St N
Fargo, ND 58102
Phone (701) 234-6161

2400 32nd Ave S
Fargo, ND 58103
Phone (701) 234-8800

2422 20th St SW
Jamestown, ND 58401
Phone (701) 252-1050

1220 Sheyenne St
West Fargo, ND 58078
Phone (701) 234-4445

Organizations & group practices 6

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 12

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": "1369094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568678400000",
    "number": "1306282025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 4TH ST N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581024539",
            "telephone_number": "701-234-6161",
            "fax_number": "701-234-7592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 4TH ST N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581024539",
            "telephone_number": "701-234-6161",
            "fax_number": "701-234-7592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIISANEN",
        "first_name": "JEFFREY",
        "middle_name": "MARK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-21",
        "last_updated": "2019-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "58264",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "MN",
            "license": "58264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.