Active NPI
Michael G Wissler, DO
- Family Medicine Physician
- Orefield, PA
National Provider Identifier
1497741094
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 05010543L
- Practice address
- 5300 Kidspeace Dr
Kidspeace National Centers, Inc.
Orefield, PA 18069-2044 - Phone
- (610) 799-8853
- Fax
- (610) 799-8001
- NPI assigned
- Sep 20, 2005
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 05010543L | PA | Primary |
Addresses
Primary practice location
5300 Kidspeace Dr
Kidspeace National Centers, Inc.
Orefield, PA 18069-2044
Mailing address
5300 Kidspeace Dr
Orefield, PA 18069-2044
Phone (610) 799-8853
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 102505900-0001 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05010543L | PA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1497741094",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5300 KIDSPEACE DR",
"city": "OREFIELD",
"state": "PA",
"postal_code": "180692044",
"telephone_number": "610-799-8853",
"fax_number": "610-799-8001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5300 KIDSPEACE DR",
"address_2": "KIDSPEACE NATIONAL CENTERS, INC.",
"city": "OREFIELD",
"state": "PA",
"postal_code": "180692044",
"telephone_number": "610-799-8853",
"fax_number": "610-799-8001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISSLER",
"first_name": "MICHAEL",
"middle_name": "G",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-20",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "PA",
"license": "05010543L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "102505900-0001",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Orefield, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.