Individual provider Active NPI

Michael Todd Wietmarschen, AT

  • Surgical Physician Assistant
  • Columbus, OH
National Provider Identifier
1457434508
Registry record updated Jan 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
50.003003 Issued in OH
Practice address
323 E Town St
Columbus, OH 43215-4767
Phone
(614) 461-8714
Fax
(614) 461-9155
NPI assigned
Oct 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X AT002804 OH
Surgical Physician Assistant 363AS0400X 50.003003 OH Primary

Addresses

Primary practice location

323 E Town St
Columbus, OH 43215-4767

Mailing address

5400 Frantz Rd
Ste 250
Dublin, OH 43016-4144
Phone (614) 544-6382

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mwietmarschen22548@direct.ohiohealth.com OhioHealth Physician Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091106000568 OH Practitioner - Physician Assistant 7719025063 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ohiohealth CorporationGroup PAC ID 6305758426, 2,295 clinicians

Practice addresses (Care Compare)

111 S Grant Ave
Columbus, OH 43215-4701

111 S Grant Ave 3Rd FL
Columbus, OH 43215-4701
Phone (614) 566-9184

285 E State St
Suite 400
Columbus, OH 43215-4354
Phone (614) 566-7370

300 Polaris Pkwy
Westerville, OH 43082-7989

303 E Town St
Columbus, OH 43215-4601
Phone (614) 533-6600

393 E Town St
Columbus, OH 43215-4799

417 Hill Rd N
Pickerington, OH 43147-1310
Phone (614) 461-8174

Hospital & facility affiliations

  • Grant Medical Center Hospital, Columbus, OH, CCN 360017

Merit-based Incentive Payment System (MIPS)

Final score
80.04 of 100Reported as group
Quality
58.67
Promoting interoperability
98
Improvement activities
40
Cost
76.46

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
AT002804OHMDAthletic Trainer
50.003003OHMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ohiohealth Corporation CurrentSince Sep 1, 2016 Accepting new patients
Ohiohealth Corporation CurrentSince Sep 1, 2016 Accepting new patients
Ohiohealth Regional Physician Services, LLC PastSince Feb 1, 2022 Accepting new patients
Sports Medicine Grant, Inc Past Accepting new patients

Locations

303 E Town St
Columbus, OH 43215
Phone (614) 788-5000

393 E Town St
Ste 116
Columbus, OH 43215
Phone (614) 566-9108

323 E Town St
Columbus, OH 43215
Phone (614) 461-8174

Dept L3652
Columbus, OH 43260

5400 Frantz Rd
Ste 250
Dublin, OH 43016
Phone (614) 544-6161

2030 Stringtown Rd
Ste 200
Grove City, OH 43123
Phone (614) 544-0054

417 Hill Rd N
Pickerington, OH 43147
Phone (614) 833-5520

300 Polaris Pkwy
Ste 220
Westerville, OH 43082
Phone (614) 533-3210

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643068800000",
    "number": "1457434508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5400 FRANTZ RD",
            "address_2": "STE 250",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430164144",
            "telephone_number": "614-544-6382",
            "fax_number": "614-544-6370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 E TOWN ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432154767",
            "telephone_number": "614-461-8714",
            "fax_number": "614-461-9155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIETMARSCHEN",
        "first_name": "MICHAEL",
        "middle_name": "TODD",
        "name_prefix": "Mr.",
        "credential": "AT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-23",
        "last_updated": "2022-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "OH",
            "license": "AT002804",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OH",
            "license": "50.003003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mwietmarschen22548@direct.ohiohealth.com",
            "affiliation": "Y",
            "affiliationName": "OhioHealth Physician Group",
            "address_1": "303 E Town St",
            "city": "Columbus",
            "state": "OH",
            "country_code": "US",
            "postal_code": "432154601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.