Elliott Wise, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

11264 Issued in MN

Practice address

9645 Grove Cir N Ste 200
Maple Grove, MN 55369-2684

Phone

(763) 201-8191

Fax

(763) 201-8192

NPI assigned

Jul 9, 2012

Sex

Male

Sole proprietor

No

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 MN

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

Specialty

Physician Assistant

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Interventional Spine and Pain Physicians PAGroup PAC ID 2466606264, 42 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Interventional Spine and Pain Physicians, PA

  • Specialist
  • Maple Grove, MN
  • NPI 1326398561
  Medicare reassignment Care Compare group
• Fairview Health Services

  • Emergency Medicine Physician
  • Minneapolis, MN
  • NPI 1811077175
  Medicare reassignment
• Fairview Health Services

  • Land Ambulance
  • Saint Paul, MN
  • NPI 1710212485
  NPD
• Fairview Health Services

  • Hospitalist Physician
  • Burnsville, MN
  • NPI 1952499444
  NPD
• Anesthesia Associates, PLLC

  • Specialist
  • Maple Grove, MN
  • NPI 1104176205
  NPD (past)

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

{
    "created_epoch": "1341792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564531200000",
    "number": "1477818292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9645 GROVE CIR N STE 200",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553692684",
            "telephone_number": "763-201-8191",
            "fax_number": "763-201-8192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9645 GROVE CIR N STE 200",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553692684",
            "telephone_number": "763-201-8191",
            "fax_number": "763-201-8192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISE",
        "first_name": "ELLIOTT",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-09",
        "last_updated": "2019-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "11264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia Marie Wiltgen, LICSW
• Barrett Wingard, OD
• Rachel Grace Wingbermuehle, FNP-BC
• Lisa Winter
• Wisconsin Lutheran Child & Family Service ,Inc.
• Scott D Wissink, MD
• Lauren Bachnick Witebsky, APRN
• Jamie Witt, PA-C
• Katti Lauren Woerner, D.O
• Jennifer Woessner

• Physician Assistant in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Physician Assistant in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2019; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.