Active NPI
Barry R Wiss, D.O.
- Gastroenterology Physician
- Glendale, AZ
National Provider Identifier
1366419434
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- 2029
- Practice address
- 5823 W Eugie Ave
Ste a
Glendale, AZ 85304-1276 - Phone
- (602) 843-1265
- Fax
- (602) 843-1297
- NPI assigned
- Mar 7, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | 2029 | AZ | Primary |
Addresses
Primary practice location
5823 W Eugie Ave
Ste a
Glendale, AZ 85304-1276
Mailing address
3707 N 7TH St
#305
Phoenix, AZ 85014-5059
Phone (602) 264-9100
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 120390 | Other | AZ | GROUP MEDICARE NUMBER |
| 290445-06 | Medicaid | AZ | |
| 290445 02 | Medicaid | AZ | |
| 317047 | Other | AZ | GROUP MEDICAID NUMBER |
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 Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Arizona Digestive Health, PC | Gastroenterology | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Gastroenterology Physician
- Scottsdale, AZ
- NPI 1992981583
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141689600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211328000000",
"number": "1366419434",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3707 N 7TH ST",
"address_2": "#305",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850145059",
"telephone_number": "602-264-9100",
"fax_number": "602-264-9101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5823 W EUGIE AVE",
"address_2": "STE A",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853041276",
"telephone_number": "602-843-1265",
"fax_number": "602-843-1297"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISS",
"first_name": "BARRY",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-07",
"last_updated": "2008-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "AZ",
"license": "2029",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP MEDICARE NUMBER",
"identifier": "120390",
"state": "AZ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "290445-06",
"state": "AZ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "290445 02",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP MEDICAID NUMBER",
"identifier": "317047",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glendale, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 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.