Jessica Wise, M.D.

Primary specialty

Surgical Critical Care PhysicianTaxonomy code 2086S0102X

License

158015 Issued in FL

Practice address

320 Racetrack Rd NW Ste 100B
Fort Walton Beach, FL 32547-1796

Phone

(850) 374-9610

Fax

(850) 374-9611

NPI assigned

May 1, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

General SurgeryAlso: Critical Care (Intensivists)

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Florida Trauma Services LLCGroup PAC ID 3971985938, 92 clinicians

Northwest Florida Multispecialty Physicians LLCGroup PAC ID 5597801779, 16 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• HCA Florida Fort Walton-Destin Hospital Hospital, Fort Walton Beach, FL, CCN 100223

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jessica.wise@hca5.eclinicaldirectplus.com

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.

• Florida Trauma Services, LLC

  • Trauma Surgery Physician
  • Fort Walton Beach, FL
  • NPI 1477296952
  Medicare reassignment Care Compare group NPD
• Northwest Florida Multispecialty Physicians LLC

  • Neurological Surgery Physician
  • Fort Walton Beach, FL
  • NPI 1790912269
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Fort Walton Beach Medical Center, Inc.

  dba HCA Florida Fort Walton-Destin Hospital

  • General Acute Care Hospital
  • Ft Walton Beach, FL
  • NPI 1639128820
  Care Compare affiliation

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

{
    "created_epoch": "1462060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658793600000",
    "number": "1336594050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 RACETRACK RD NW STE 100B",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325471796",
            "telephone_number": "850-374-9610",
            "fax_number": "850-374-9611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 RACETRACK RD NW STE 100B",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325471796",
            "telephone_number": "850-374-9610",
            "fax_number": "850-374-9611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISE",
        "first_name": "JESSICA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-01",
        "last_updated": "2022-07-26",
        "certification_date": "2022-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "FL",
            "license": "158015",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "158015",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "FL",
            "license": "158015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1336594050",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Reemeka Lasha Wilson, MASTER OF SCIENCE
• Beverly Wilusz, LMHC
• Abbey Winblad, PT
• Robert Edward Winkler Jr., ATC
• Anne Wise, L.M.H.C.
• Sharon Renee Wise, LMHC
• Matthew Wisniewski, PTA
• Andrea J Witt, CRNA
• Gavin Payne Wolfe
• Tade L Wolfe, MA, CCC-SLP

• Surgical Critical Care Physician in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Surgical Critical Care Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 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.