NPIMap

Individual provider Active NPI

Chelsea Ann Wiesner, DO

  • Emergency Medicine Physician
  • Brainerd, MN
National Provider Identifier
1487210811
Registry record updated Feb 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
75714 Issued in MN
Practice address
523 N 3Rd St
Brainerd, MN 56401-3054
Phone
(218) 829-2861
NPI assigned
May 10, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 9209 AZ
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X 75714 MN Primary

Addresses

Primary practice location

523 N 3Rd St
Brainerd, MN 56401-3054

Mailing address

1702 University Dr S
Fargo, ND 58103-4940

Other practice location 1

3269 N Stockton Hill Rd
Kingman, AZ 86409-3619
Phone (507) 208-8367

Other practice location 2

807 S Ponderosa St
Payson, AZ 85541-5542
Phone (520) 474-3222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, MN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20211222001765 AZ Practitioner - Emergency Medicine 4385035542 Reassigns benefits to 1 organization
I20240306000356 MN Practitioner - Emergency Medicine 4385035542 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Josephs Medical CenterGroup PAC ID 8224948443, 238 clinicians

Practice addresses (Care Compare)

523 N 3Rd St
Brainerd, MN 56401-3054
Phone (218) 828-7400

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9209AZMDEmergency Medicine Physician
75714MNMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Moose Lake Community Hospital District Current Accepting new patients
Deer River Healthcare Center, Inc CurrentSince Jun 24, 2024 Accepting new patients
Pine Medical Center CurrentSince Jun 24, 2024 Accepting new patients
St. Joseph'S Medical Center CurrentSince Mar 25, 2024 Accepting new patients
Deer River Healthcare Center, Inc. Current Accepting new patients
Deer River Healthcare Center, Inc. CurrentSince Jun 24, 2024 Accepting new patients
St. Joseph'S Medical Center Current Accepting new patients
Essentia Health Moose Lake CurrentSince Jun 24, 2024 Accepting new patients
Emergency Physicians Southwest, PC Emergency Medicine CurrentSince Dec 1, 2021 Accepting new patients
Pine Medical Center Current Accepting new patients
Essentia Health Moose Lake Current Accepting new patients
St Joseph'S Medical Center CurrentSince Mar 25, 2024 Accepting new patients

Locations

6644 E Baywood Ave
Mesa, AZ 85206
Phone (480) 321-2000

807 S Ponderosa St
Payson, AZ 85541
Phone (520) 474-3222

523 N 3rd St
Brainerd, MN 56401
Phone (218) 828-7394

115 10th Ave NE
#A
Deer River, MN 56636
Phone (218) 246-8275

115 10th Ave NE
Deer River, MN 56636
Phone (218) 246-2900

4572 County Road 61
Moose Lake, MN 55767
Phone (218) 485-4481

705 Lundorff Dr
Sandstone, MN 55072
Phone (320) 245-2211

Organizations & group practices 12

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 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1557446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708473600000",
    "number": "1487210811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 UNIVERSITY DR S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581034940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "523 N 3RD ST",
            "city": "BRAINERD",
            "state": "MN",
            "postal_code": "564013054",
            "telephone_number": "218-829-2861"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3269 N Stockton Hill Rd",
            "address_purpose": "LOCATION",
            "city": "Kingman",
            "state": "AZ",
            "postal_code": "864093619",
            "country_code": "US",
            "telephone_number": "507-208-8367",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "807 S Ponderosa St",
            "address_purpose": "LOCATION",
            "city": "Payson",
            "state": "AZ",
            "postal_code": "855415542",
            "country_code": "US",
            "telephone_number": "520-474-3222",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIESNER",
        "first_name": "CHELSEA",
        "middle_name": "ANN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-10",
        "last_updated": "2024-02-21",
        "certification_date": "2024-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AZ",
            "license": "9209",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MN",
            "license": "75714",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brainerd, MN

Sources for this page

Verify at the official NPI Registry.