Matthew Keith Wise, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

45216 Issued in AZ

Practice address

Nau Campus Health Services
824 South San Francisco St
Flagstaff, AZ 86001

Phone

(928) 523-2131

Fax

(928) 527-4327

NPI assigned

Jun 14, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Homer Medical Clinic, a Professional Corp

  • Family Medicine Physician
  • Homer, AK
  • NPI 1134277312

  Family Medicine

  NPD
• Az BD of Regents for on Behalf of Northern Az University

  • Primary Care Clinic/Center
  • Flagstaff, AZ
  • NPI 1891727863
  NPD (past)

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688083200000",
    "number": "1497798714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6033",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "86011",
            "telephone_number": "928-523-2131",
            "fax_number": "928-527-4327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "NAU CAMPUS HEALTH SERVICES",
            "address_2": "824 SOUTH SAN FRANCISCO ST",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "86001",
            "telephone_number": "928-523-2131",
            "fax_number": "928-527-4327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISE",
        "first_name": "MATTHEW",
        "middle_name": "KEITH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AK",
            "license": "AA4327",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "45216",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD8586",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "840513",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Winandy, PT, DPT
• Kent D Winkler, M.D.
• Erin Winter, NMD
• Dakota Wise, MD
• Irene Manalisay Wise, FNP RN
• Lynn Spangenberg Wisniewski
• Rebecca Elaine Witt, R.N.
• James Michael Wittekind, P.T., D.P.T.
• Laura R Wittke, MS RD
• Michaela Wixom

• Family Medicine Physician in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.