Individual provider Active NPI

Daniel Wesemann, LISW, ARNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Davenport, IA
National Provider Identifier
1366435125
Registry record updated Apr 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
G115152 Issued in IA
Practice address
4455 E 56TH St
Davenport, IA 52807-2995
Phone
(563) 355-2577
Fax
(563) 355-4015
NPI assigned
Aug 26, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 149009939 IL
Clinical Social Worker 1041C0700X 06158 IA
Psychiatric/Mental Health Registered Nurse 163WP0808X 115152 IA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X G115152 IA Primary

Addresses

Primary practice location

4455 E 56TH St
Davenport, IA 52807-2995

Mailing address

4455 E 56TH St
Davenport, IA 52807-2995
Phone (563) 355-2577

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Daniel.wesemann@direct.genesishealth.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090512000425 IA Practitioner - Nurse Practitioner 5193707172 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Genesis Health SystemGroup PAC ID 7214841436, 217 clinicians

Practice addresses (Care Compare)

4455 E 56TH St
Mercyone Genesis Psychology Associa
Davenport, IA 52807-2995
Phone (563) 355-2577

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
06158IAMDClinical Social Worker
149009939ILMDClinical Social Worker
115152IAMDPsychiatric/Mental Health Registered Nurse
G115152IAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
State University of Iowa CurrentSince Jul 1, 2016 Accepting new patients
Genesis Health System CurrentSince Mar 9, 2009 Accepting new patients
Genesis Health System CurrentSince Jan 1, 2020 Accepting new patients
Genesis Health System Current Accepting new patients
State University of Iowa Psychiatric/Mental Health CurrentSince Jul 1, 2016 Accepting new patients
Genesis Health System CurrentSince Jan 1, 2020 Accepting new patients
Genesis Health System CurrentSince Mar 9, 2009 Accepting new patients
Southpark Psychology LTD Clinical PastSince Jan 1, 2013 Accepting new patients

Locations

865 Lincoln Rd
Ste 100
Bettendorf, IA 52722
Phone (563) 355-1000

4700 E 56th St
Ste 100
Davenport, IA 52807
Phone (563) 383-2667

1401 W Central Park Ave
Davenport, IA 52804
Phone (563) 421-1900

4455 E 56th St
Davenport, IA 52807
Phone (563) 355-2577

210 W 53rd St
Davenport, IA 52806
Phone (563) 386-3436

619 5th St
Durant, IA 52747
Phone (563) 785-4487

200 Hawkins Dr
Iowa City, IA 52242
Phone (319) 356-1616

101 College of Nursing Bldg
Iowa City, IA 52242
Phone (319) 248-1267

Interoperability endpoints

  • Direct secure messaging: daniel.wesemann@direct.genesishealth.com
  • Direct secure messaging: stateuniversityofiowacollegeofnursing.danielwesemann@136738.advancedmd-direct.com

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1125014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618963200000",
    "number": "1366435125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4455 E 56TH ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528072995",
            "telephone_number": "563-355-2577",
            "fax_number": "563-355-4015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4455 E 56TH ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528072995",
            "telephone_number": "563-355-2577",
            "fax_number": "563-355-4015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WESEMANN",
        "first_name": "DANIEL",
        "name_prefix": "Mr.",
        "credential": "LISW, ARNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-26",
        "last_updated": "2021-04-21",
        "certification_date": "2021-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149009939",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IA",
            "license": "06158",
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "IA",
            "license": "115152",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IA",
            "license": "G115152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Daniel.wesemann@direct.genesishealth.com",
            "affiliation": "N",
            "endpointDescription": "Genesis Health System Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "4455 E 56th St",
            "city": "Davenport",
            "state": "IA",
            "country_code": "US",
            "postal_code": "528072995",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

Verify at the official NPI Registry.