Active NPI
Maurits J. Wiersema, MD
- Gastroenterology Physician
- New Bern, NC
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- 2018-01881
- Practice address
- 2604 Dr Martin Luther King Jr Blvd
New Bern, NC 28562-4238 - Phone
- (252) 636-4502
- Fax
- (252) 633-2785
- NPI assigned
- Jun 12, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | 01039203A | IN | |
| Gastroenterology Physician | 207RG0100X | 2018-01881 | NC | Primary |
Addresses
Primary practice location
2604 Dr Martin Luther King Jr Blvd
New Bern, NC 28562-4238
Mailing address
PO Box 68
Pollocksville, NC 28573-0068
Phone (252) 635-3906
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100176630 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Gastroenterology
- Education
- Indiana University School of Medicine, 1982
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1606 No 7TH St
Union Hospital Inc
Terre Haute, IN 47804-2706
Phone (812) 238-7000
Hospital & facility affiliations
- Union Hospital Inc
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Colonoscopy | 45 |
| Upper gastrointestinal (GI) endoscopy for acid reflux | 59 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01039203A | IN | MD | Gastroenterology Physician |
| 2018-01881 | NC | MD | Gastroenterology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Union Associated Physicians Clinic, LLC | Current | Accepting new patients | |
| Union Associated Physicians Clinic LLC | Current | Accepting new patients | |
| Indiana Medical Associates, LLC | Past | Accepting new patients |
Locations
221 S 6th St
Terre Haute, IN 47807
Phone (812) 242-3157
1606 N 7th St
Terre Haute, IN 47804
Phone (812) 238-7523
1429 N 6th St
Terre Haute, IN 47807
Phone (812) 242-3115
1429 N 6th St
Ofc
Terre Haute, IN 47807
Organizations & group practices 3
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.
-
- Family Medicine Physician
- Terre Haute, IN
- NPI 1891028379
-
- Dermatology Physician
- Terre Haute, IN
- NPI 1407404940
-
- Internal Medicine Physician
- Fort Wayne, IN
- NPI 1780628545
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Terre Haute, IN
- NPI 1619975331
-
- General Acute Care Hospital
- Terre Haute, IN
- NPI 1821859752
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550188800000",
"number": "1316989692",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 68",
"city": "POLLOCKSVILLE",
"state": "NC",
"postal_code": "285730068",
"telephone_number": "252-635-3906",
"fax_number": "252-224-0378"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2604 DR MARTIN LUTHER KING JR BLVD",
"city": "NEW BERN",
"state": "NC",
"postal_code": "285624238",
"telephone_number": "252-636-4502",
"fax_number": "252-633-2785"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIERSEMA",
"first_name": "MAURITS",
"middle_name": "J.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-12",
"last_updated": "2019-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "IN",
"license": "01039203A",
"primary": false
},
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "NC",
"license": "2018-01881",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100176630",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in New Bern, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2019; 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.