Jeffrey Wishik, MD

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

MD07160 Issued in RI

Practice address

1 Randall SQ
Suite 409
Providence, RI 02904-2709

Phone

(401) 274-5150

Fax

(401) 274-5130

NPI assigned

Jan 25, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Brain Mapping and Computerized Neurophsiology Laboratory, Inc

  • Physiological Laboratory
  • Providence, RI
  • NPI 1720136419
  NPD Authorized official
• Jeffrey Wishik MD

  • Neurology Physician
  • Providence, RI
  • NPI 1376718718
  NPD Authorized official

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196208000000",
    "number": "1447305636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 RANDALL SQ",
            "address_2": "SUITE 409",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029042709",
            "telephone_number": "401-274-5150",
            "fax_number": "401-274-5130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 RANDALL SQ",
            "address_2": "SUITE 409",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029042709",
            "telephone_number": "401-274-5150",
            "fax_number": "401-274-5130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISHIK",
        "first_name": "JEFFREY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-25",
        "last_updated": "2007-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "RI",
            "license": "MD07160",
            "primary": true
        },
        {
            "code": "2084N0600X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": "RI",
            "license": "MD07160",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000115",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrea Winter
• Bruce Winter, MD
• Joanna L Winterbottom, LICSW
• Melissa J Wirth, LCSW
• Sarah Wise, OD
• Jennifer Wishtischin
• Libbi Wissekerke, PA-C
• Bridgit Anne Witbeck
• With Love Transportation
• Sabrina Maria Witherby, M.D.

• Neurology Physician in Providence, RI
• Providers in Providence, RI by specialty
• Neurology Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.