Trent Matthew Wiedemann

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

334753 Issued in LA

Practice address

478 S Johnson St
New Orleans, LA 70112-2238

Phone

(504) 412-1580

NPI assigned

Mar 24, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Louisiana State University School of Medicine in New Orleans Faculty G

  dba LSU Healthcare Network

  • Multi-Specialty Clinic/Center
  • New Orleans, LA
  • NPI 1477582526

  Single Specialty

  NPD (past)
• Commonwealth of Virginia Catawba Hospital

  • Psychiatric Hospital
  • Catawba, VA
  • NPI 1518981869
  NPD (past)

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

{
    "created_epoch": "1585008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691452800000",
    "number": "1417584145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "478 S JOHNSON ST FL 7",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701122238",
            "telephone_number": "504-412-1580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "478 S JOHNSON ST",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701122238",
            "telephone_number": "504-412-1580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIEDEMANN",
        "first_name": "TRENT",
        "middle_name": "MATTHEW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-03-24",
        "last_updated": "2023-08-08",
        "certification_date": "2023-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "LA",
            "license": "334753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Terrance Wickman
• Nimmi Nimesha Wickramasuriya, M.D.
• Christian Widdows, M.D.
• Kyle Emily Widmer, M.D.
• Brannon Elizabeth Wiedemann, M.D.
• Joshua James Wiegmann, PT
• Dustin Wielt, PH.D.
• Jeffrey Grant Wiese, MD
• Angela R. Wiggins, MSW, LCSW-BACS
• Katherine Wikrent, MS, PLPC

• Psychiatry Physician in New Orleans, LA
• Providers in New Orleans, LA by specialty
• Psychiatry Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.