Individual provider Active NPI

Jennifer Frances Wiseman, MSW, LICSW

  • Social Worker
  • Minnetonka, MN
National Provider Identifier
1497877740
Registry record updated Dec 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
12336 Issued in MN
Practice address
13100 Wayzata Blvd Ofc Ctr
Minnetonka, MN 55305-1802
Phone
(952) 206-2040
NPI assigned
Apr 6, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 12336 MN Primary

Addresses

Primary practice location

13100 Wayzata Blvd Ofc Ctr
Minnetonka, MN 55305-1802

Mailing address

5301 Michaele LN
Minnetonka, MN 55345-4225
Phone (651) 788-3945

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230328002821 MN Practitioner - Clinical Social Worker 4385018662 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
University of Minnesota Medical School, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Healthwise Psychology PAGroup PAC ID 2567685647, 32 clinicians

Practice addresses (Care Compare)

18205 45TH Ave N
Plymouth, MN 55446-4551
Phone (763) 400-7828

Merit-based Incentive Payment System (MIPS)

Final score
88.63 of 100Reported as group
Quality
75.41
Promoting interoperability
100
Improvement activities
40
Cost
75.75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12336MNMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Healthwise Psychology, PA CurrentSince May 28, 2024 Accepting new patients
Fairview Health Services Current Accepting new patients
Fairview Health Services CurrentSince Aug 1, 2023 Accepting new patients
Fairview Express Care CurrentSince Aug 1, 2023 Accepting new patients
Fairview Express Care CurrentSince Aug 1, 2023 Accepting new patients
Fairview Express Care Current Accepting new patients
Scott M Yarosh, LLC PastSince Dec 15, 2009 Accepting new patients

Locations

11280 86th Ave N
Maple Grove, MN 55369
Phone (763) 400-7828

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

717 Delaware St SE
Ste 340
Minneapolis, MN 55414
Phone (612) 625-3617

18205 45th Ave N
Plymouth, MN 55446
Phone (763) 400-7828

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

3305 Central Park Village Dr
Ste 200
Saint Paul, MN 55121
Phone (651) 406-8860

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670198400000",
    "number": "1497877740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5301 MICHAELE LN",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553454225",
            "telephone_number": "651-788-3945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13100 WAYZATA BLVD OFC CTR",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553051802",
            "telephone_number": "952-206-2040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISEMAN",
        "first_name": "JENNIFER",
        "middle_name": "FRANCES",
        "credential": "MSW, LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-06",
        "last_updated": "2022-12-05",
        "certification_date": "2022-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MN",
            "license": "12336",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minnetonka, MN

Sources for this page

Verify at the official NPI Registry.