NPIMap

Individual provider Active NPI

Channing C Wiersema, MD

  • Family Medicine Physician
  • Plover, WI
National Provider Identifier
1457416166
Registry record updated May 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
38945 Issued in WI
Practice address
2401 Plover Rd
Plover, WI 54467-3916
Phone
(715) 295-3800
NPI assigned
Dec 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2008

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 38945 WI Primary

Addresses

Primary practice location

2401 Plover Rd
Plover, WI 54467-3916

Mailing address

900 Illinois Ave
Stevens Point, WI 54481-3114

Other identifiers 1

IdentifierTypeStateIssuer
32381800MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20050129000156 WI Practitioner - Family Practice 5991755605 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Wisconsin, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aspirus Stevens Point Hospital and Clinics, Inc.Group PAC ID 1850358938, 136 clinicians
Aspirus Rhinelander and Tomahawk Hospitals and Clinics, Inc.Group PAC ID 9335059856, 566 clinicians

Practice addresses (Care Compare)

190 Grand Seasons Dr
Waupaca, WI 54981-8219
Phone (715) 258-3650

205 S Main St
Iola, WI 54945-9685
Phone (715) 623-2351

824 Illinois Ave
Stevens Point, WI 54481-3112
Phone (715) 344-1600

900 Illinois Ave
Stevens Point, WI 54481-3114
Phone (715) 346-5000

Hospital & facility affiliations

  • Aspirus Stevens Point Hospital & Clinics, Inc. Hospital, Stevens Point, WI, CCN 520002
  • Aspirus Rhinelander Hospital Hospital, Rhinelander, WI, CCN 520019
  • Aspirus Wausau Hospital Hospital, Wausau, WI, CCN 520030
  • Aspirus Riverview Hospital & Clinics Inc Hospital, Wisconsin Rapids, WI, CCN 520033

Merit-based Incentive Payment System (MIPS)

Final score
87.15 of 100Reported as group
Quality
73.7
Promoting interoperability
100
Improvement activities
40
Cost
76.71

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Aspirus Stevens Point Hospital & Clinics, Inc. CurrentSince Jun 1, 2005 Accepting new patients
Aspirus Rhinelander & Tomahawk Hospitals & Clinics, Inc. CurrentSince Jul 1, 2023 Accepting new patients
Aspirus Rhinelander & Tomahawk Hospitals & Clinics, Inc. CurrentSince Jul 1, 2023 Accepting new patients
Aspirus Stevens Point Hospital & Clinics, Inc. CurrentSince Jun 1, 2005 Accepting new patients
Aspirus Rhinelander & Tomahawk Hospitals & Clinics, Inc. Past Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

400 W Glen St
Crandon, WI 54520
Phone (715) 478-3318

2401 Plover Rd
Plover, WI 54467
Phone (715) 259-3800

2251 N Shore Dr
Ste 100
Rhinelander, WI 54501
Phone (715) 361-2074

1020 Kabel Ave
Rhinelander, WI 54501
Phone (715) 361-2805

824 Illinois Ave
Stevens Point, WI 54481
Phone (715) 342-7500

900 Illinois Ave
Stevens Point, WI 54481
Phone (715) 342-7500

401 W Mohawk Dr
Ste 100
Tomahawk, WI 54487
Phone (715) 453-7700

190 Grand Seasons Dr
Waupaca, WI 54981
Phone (715) 258-3401

Interoperability endpoints

  • Direct secure messaging: cwiersema169809@direct.aspirus.org

Organizations & group practices 19

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.

View all 19

Hospital & facility affiliations 30

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

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1166745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211846400000",
    "number": "1457416166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 ILLINOIS AVE",
            "city": "STEVENS POINT",
            "state": "WI",
            "postal_code": "544813114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 PLOVER RD",
            "city": "PLOVER",
            "state": "WI",
            "postal_code": "544673916",
            "telephone_number": "715-295-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIERSEMA",
        "first_name": "CHANNING",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-22",
        "last_updated": "2008-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "38945",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32381800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plover, WI

Sources for this page

Verify at the official NPI Registry.