Active NPI
Rae Wisler, M.D.
- Psychiatry Physician
- Vancouver, WA
National Provider Identifier
1356401103
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- WA00031984
- Practice address
- 4603 NE St Johns Rd
Suite C
Vancouver, WA 98661-2587 - Phone
- (360) 254-1814
- Fax
- (360) 254-1828
- NPI assigned
- Dec 11, 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | WA00031984 | WA | Primary |
Addresses
Primary practice location
4603 NE St Johns Rd
Suite C
Vancouver, WA 98661-2587
Mailing address
4603 NE St Johns Rd
Suite C
Vancouver, WA 98661-2587
Phone (360) 254-1814
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1090455 | Medicaid | WA | |
| 601-864-528 | Other | WA | BUSINESS ID NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
Care Compare profile
Medicare Care Compare- Specialty
- Psychiatry
- Education
- Saint Louis University School of Medicine, 1990
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
4603 NE St Johns Rd
Suite C
Vancouver, WA 98661-2587
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| WA00031984 | WA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398816000000",
"number": "1356401103",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4603 NE ST JOHNS RD",
"address_2": "SUITE C",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986612587",
"telephone_number": "360-254-1814",
"fax_number": "360-254-1828"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4603 NE ST JOHNS RD",
"address_2": "SUITE C",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986612587",
"telephone_number": "360-254-1814",
"fax_number": "360-254-1828"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISLER",
"first_name": "RAE",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-11",
"last_updated": "2014-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "WA",
"license": "WA00031984",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1090455",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BUSINESS ID NUMBER",
"identifier": "601-864-528",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2014; 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.