Active NPI
Patrick Joseph Wise, DO
- Hospitalist Physician
- Fort Wayne, IN
National Provider Identifier
1407141500
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hospitalist Physician
- License
- 02004428A
- Practice address
- 6435 W Jefferson Blvd
Fort Wayne, IN 46804-6203 - Phone
- (708) 280-5693
- NPI assigned
- Jun 16, 2011
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 5101019463 | MI | |
| Student in an Organized Health Care Education/Training Program | 390200000X | 5101019463 | MI | |
| Hospitalist Physician | 208M00000X | 02004428A | IN | Primary |
Addresses
Primary practice location
6435 W Jefferson Blvd
Fort Wayne, IN 46804-6203
Mailing address
6435 W Jefferson Blvd
Fort Wayne, IN 46804-6203
Phone (708) 280-5693
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308182400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407715200000",
"number": "1407141500",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6435 W JEFFERSON BLVD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468046203",
"telephone_number": "708-280-5693"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6435 W JEFFERSON BLVD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468046203",
"telephone_number": "708-280-5693"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISE",
"first_name": "PATRICK",
"middle_name": "JOSEPH",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-16",
"last_updated": "2014-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MI",
"license": "5101019463",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "MI",
"license": "5101019463",
"primary": false
},
{
"code": "208M00000X",
"taxonomy_group": "",
"desc": "Hospitalist",
"state": "IN",
"license": "02004428A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.