Individual provider Active NPI

Maurits J. Wiersema, MD

  • Gastroenterology Physician
  • New Bern, NC
National Provider Identifier
1316989692
Registry record updated Feb 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
2018-01881 Issued in NC
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

Updated by the provider on Feb 15, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
100176630MedicaidIN

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050215000468 IN Practitioner - GastroenterologyPractitioner - Internal Medicine 5597657510 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Indiana University School of Medicine, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Union Associated Physicians Clinic, LLCGroup PAC ID 3375687437, 230 clinicians

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 Hospital, Terre Haute, IN, CCN 150023

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy45
Upper gastrointestinal (GI) endoscopy for acid reflux59

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01039203AINMDGastroenterology Physician
2018-01881NCMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Union Associated Physicians Clinic, LLC CurrentSince Jun 26, 2022 Accepting new patients
Union Associated Physicians Clinic LLC CurrentSince Jun 26, 2022 Accepting new patients
Indiana Medical Associates, LLC PastSince Jun 1, 2005 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.

Hospital & facility affiliations 2

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": "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

Verify at the official NPI Registry.