NPIMap

Individual provider Active NPI

Michael R Wisser, DO

  • Family Medicine Physician
  • Glen Mills, PA
National Provider Identifier
1386676617
Registry record updated Aug 31, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS009968L Issued in PA
Practice address
145 Brinton Lake Rd
First Floor
Glen Mills, PA 19342-2281
Phone
(610) 459-1619
Fax
(610) 459-1865
NPI assigned
Jul 7, 2006
Last updated
Aug 31, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS009968L PA Primary

Addresses

Primary practice location

145 Brinton Lake Rd
First Floor
Glen Mills, PA 19342-2281

Mailing address

145 Brinton Lake Road
First Floor
Glen Mills, PA 19342
Phone (610) 459-1619

Other identifiers 1

IdentifierTypeStateIssuer
0017882270001MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100323000742 PA Practitioner - Family Practice 3072648476 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Philadelphia College of Osteopathic Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Main Line HealthcareGroup PAC ID 1951215201, 1,154 clinicians

Practice addresses (Care Compare)

1088 W Baltimore Pike
Media, PA 19063-5146
Phone (484) 227-3863

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
OS009968LPAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prospect Health Access Network, Inc. Family Medicine CurrentSince Jul 1, 2016 Accepting new patients
Prospect Health Access Network, Inc. Current Accepting new patients
Prospect Health Access Network, Inc. Current Accepting new patients
Prospect Health Access Network, Inc. CurrentSince Jul 1, 2016 Accepting new patients
Main Line Healthcare Family Medicine CurrentSince Mar 1, 2023 Accepting new patients

Locations

830 Old Lancaster Rd
Ste 108
Bryn Mawr, PA 19010
Phone (610) 520-5200

1 Medical Center Blvd
Chester, PA 19013
Phone (610) 447-6666

1 Medical Center Blvd
Ste 301
Chester, PA 19013
Phone (610) 566-6744

145 Brinton Lake Rd
Fl 1
Glen Mills, PA 19342
Phone (610) 459-1619

1088 W Baltimore Pike
Media, PA 19063
Phone (610) 566-6744

176 S New Middletown Rd
Media, PA 19063
Phone (610) 627-3690

100 W Sproul Rd
Ste 123
Springfield, PA 19064
Phone (610) 619-8281

Interoperability endpoints

  • Direct secure messaging: michael.wisser@chpm.cernerdirect.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440979200000",
    "number": "1386676617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 BRINTON LAKE ROAD",
            "address_2": "FIRST FLOOR",
            "city": "GLEN MILLS",
            "state": "PA",
            "postal_code": "19342",
            "telephone_number": "610-459-1619",
            "fax_number": "610-459-1865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 BRINTON LAKE RD",
            "address_2": "FIRST FLOOR",
            "city": "GLEN MILLS",
            "state": "PA",
            "postal_code": "193422281",
            "telephone_number": "610-459-1619",
            "fax_number": "610-459-1865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISSER",
        "first_name": "MICHAEL",
        "middle_name": "R",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2015-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS009968L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017882270001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Mills, PA

Sources for this page

Verify at the official NPI Registry.