Active NPI
Glenn A Wiens, M.D.
- Family Medicine Physician
- Jamestown, ND
National Provider Identifier
1316971567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 5541
- Practice address
- 2430 20TH St SW
Jamestown, ND 58401-6201 - Phone
- (701) 253-5300
- Fax
- (701) 253-5402
- NPI assigned
- Jul 11, 2006
- Last updated
- Dec 23, 2015
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 5541 | ND | Primary |
Addresses
Primary practice location
2430 20TH St SW
Jamestown, ND 58401-6201
Mailing address
PO Box 6001
Fargo, ND 58108-6001
Phone (701) 253-5300
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14061 | Other | ND | BLUE CROSS OF ND |
| 16326 | Medicaid | ND | |
| 1450684 | Medicaid | ND |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5541 | MD | MD | General Practice Dentistry |
| 5541 | ND | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frances Mahon Deaconess Hospital | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1450828800000",
"number": "1316971567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 6001",
"city": "FARGO",
"state": "ND",
"postal_code": "581086001",
"telephone_number": "701-253-5300",
"fax_number": "701-253-5402"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2430 20TH ST SW",
"city": "JAMESTOWN",
"state": "ND",
"postal_code": "584016201",
"telephone_number": "701-253-5300",
"fax_number": "701-253-5402"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIENS",
"first_name": "GLENN",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-11",
"last_updated": "2015-12-23",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ND",
"license": "5541",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF ND",
"identifier": "14061",
"state": "ND"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "16326",
"state": "ND"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1450684",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jamestown, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.