Active NPI
Susan R Wiersma, MD
- Pediatric Hematology & Oncology Physician
- Cleveland, OH
National Provider Identifier
1356362776
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Hematology & Oncology Physician
- License
- 35-051050
- Practice address
- 11100 Euclid Ave
Cleveland, OH 44106-1716 - Phone
- (216) 844-7700
- Fax
- (216) 286-6341
- NPI assigned
- Jul 21, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatric Hematology & Oncology Physician | 2080P0207X | 35-051050 | OH | Primary |
Addresses
Primary practice location
11100 Euclid Ave
Cleveland, OH 44106-1716
Mailing address
3605 Warrensville Center Rd
Shaker HTS, OH 44122-5203
Phone (216) 286-6299
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 742534 | Other | OH | BUCKEYE |
| 200206560A | Other | OK | OK MEDICAID |
| 2056126 | Medicaid | OH | |
| 364131 | Other | OH | WELLCARE |
| 000000221140 | Other | OH | UNISON |
| 000000027183 | Other | OH | ANTHEM |
| 000000526169 | Other | OH | ANTHEM |
| 2056126 | Other | OH | BCMH |
| 2093513 | Other | OH | AETNA |
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 |
|---|---|---|---|
| 35-051050 | OH | MD | Pediatric Hematology & Oncology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222819200000",
"number": "1356362776",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3605 WARRENSVILLE CENTER RD",
"city": "SHAKER HTS",
"state": "OH",
"postal_code": "441225203",
"telephone_number": "216-286-6299",
"fax_number": "216-286-6341"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11100 EUCLID AVE",
"city": "CLEVELAND",
"state": "OH",
"postal_code": "441061716",
"telephone_number": "216-844-7700",
"fax_number": "216-286-6341"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIERSMA",
"first_name": "SUSAN",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-21",
"last_updated": "2008-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0207X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Hematology-Oncology",
"state": "OH",
"license": "35-051050",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BUCKEYE",
"identifier": "742534",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OK MEDICAID",
"identifier": "200206560A",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2056126",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE",
"identifier": "364131",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNISON",
"identifier": "000000221140",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000027183",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000526169",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCMH",
"identifier": "2056126",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "2093513",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cleveland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.