Individual provider Active NPI

Bradley A Wiesner, CRNA

  • Certified Registered Nurse Anesthetist
  • Grant, NE
National Provider Identifier
1508102450
Registry record updated Dec 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
101208 Issued in NE
Practice address
900 Lincoln Ave
Grant, NE 69140-3095
Phone
(308) 352-7200
Fax
(308) 352-7290
NPI assigned
Dec 21, 2012
Last updated
Dec 21, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X R 179376-9 MN
Certified Registered Nurse Anesthetist 367500000X 101208 NE Primary

Addresses

Primary practice location

900 Lincoln Ave
Grant, NE 69140-3095

Mailing address

900 Lincoln Ave
Grant, NE 69140-3095
Phone (308) 352-7200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130906000508 NE Practitioner - Certified Registered Nurse Anesthetist (Crna) 1254574478 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Perkins County Hospital DistrictGroup PAC ID 0840109823, 22 clinicians

Practice addresses (Care Compare)

900 Lincoln Ave
Grant, NE 69140-3095
Phone (308) 352-7200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
31.28 of 100Reported as group
Quality
19.15
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
R 179376-9MNMDCertified Registered Nurse Anesthetist
101208NEMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Perkins County Hospital District CurrentSince Jan 1, 2019 Accepting new patients
Perkins County Hospital District CurrentSince Jan 1, 2019 Accepting new patients
Perkins County Hospital District Past Accepting new patients

Locations

900 Lincoln Ave
Grant, NE 69140
Phone (308) 352-7200

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1356048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545350400000",
    "number": "1508102450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 LINCOLN AVE",
            "city": "GRANT",
            "state": "NE",
            "postal_code": "691403095",
            "telephone_number": "308-352-7200",
            "fax_number": "308-352-7290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 LINCOLN AVE",
            "city": "GRANT",
            "state": "NE",
            "postal_code": "691403095",
            "telephone_number": "308-352-7200",
            "fax_number": "308-352-7290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIESNER",
        "first_name": "BRADLEY",
        "middle_name": "A",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-12-21",
        "last_updated": "2018-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "R 179376-9",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NE",
            "license": "101208",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grant, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.