Bradley A Wiesner, CRNA
Individual provider Active NPI Certified Registered Nurse Anesthetist · Grant, NE
NPI 1508102450 · NPPES record last updated Dec 21, 2018
Key facts
- NPI
- 1508102450
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- 101208 (NE)
- Practice address
- 900 Lincoln Ave
Grant, NE 69140-3095 - Phone
- (308) 352-7200
- Fax
- (308) 352-7290
- NPI assigned
- Dec 21, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 1
Medicare Care Compare profile
- 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 District
Practice addresses (Care Compare)
900 Lincoln Ave
Grant, NE 69140-3095
Phone (308) 352-7200
Hospital & facility affiliations
- Perkins County Health Services
Merit-based Incentive Payment System (MIPS)
- Final score
- 31.28 of 100
- Quality
- 19.15
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NE
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130906000508 | NE | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 1254574478 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R 179376-9 | MN | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Perkins County Hospital District | Current |
Accepting new patients | |
| Perkins County Hospital District | Current |
Accepting new patients | |
| Perkins County Hospital District | Past | Accepting new patients |
Locations
900 Lincoln Ave
Grant, NE 69140
Phone (308) 352-7200
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | R 179376-9 | MN | |
| Certified Registered Nurse Anesthetist | 367500000X | 101208 | NE | Yes |
Addresses
Primary practice location
900 Lincoln Ave
Grant, NE 69140-3095
Mailing address
900 Lincoln Ave
Grant, NE 69140-3095
Phone (308) 352-7200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10025589400 | Medicaid | NE |
Other providers in Grant, NE
- Lauren Sexson
- Ashley Brianne Smith
- Marvin Allen Swan
- Keith Edward Sykes
- Western Sky Community Care Center Inc
All providers in Grant, NE · Certified Registered Nurse Anesthetist in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 21, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.