Active NPI
Lance Jordan Wiist, M.D.
- Obstetrics & Gynecology Physician
- Lawrenceville, GA
National Provider Identifier
1487708103
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 033754
- Practice address
- 761 Old Norcross Rd
Lawrenceville, GA 30046-4317 - Phone
- (770) 513-4000
- NPI assigned
- Jan 22, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 033754 | GA | Primary |
Addresses
Primary practice location
761 Old Norcross Rd
Lawrenceville, GA 30046-4317
Mailing address
761 Old Norcross Rd
Lawrenceville, GA 30046-4317
Phone (770) 513-4000
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00446993A | Medicaid | GA | |
| 619666 | Other | GA | BLUE CROSS BLUE SHIELD GA |
| 160054732 | Other | GA | PALMETTO GBA RAILROAD |
| 000446993A | Other | GA | PEACHSTATE |
| 00446993A | Other | GA | WELLCARE |
Medicare participation
Medicare enrollment files- 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
- Opted out of Medicare
- Yes, effective Jul 1, 2017 through Jul 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 033754 | GA | MD | Obstetrics & Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323993600000",
"number": "1487708103",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "761 OLD NORCROSS RD",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300464317",
"telephone_number": "770-513-4000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "761 OLD NORCROSS RD",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300464317",
"telephone_number": "770-513-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIIST",
"first_name": "LANCE",
"middle_name": "JORDAN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-22",
"last_updated": "2011-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "GA",
"license": "033754",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00446993A",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD GA",
"identifier": "619666",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PALMETTO GBA RAILROAD",
"identifier": "160054732",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PEACHSTATE",
"identifier": "000446993A",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE",
"identifier": "00446993A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lawrenceville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2011; 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.