Active NPI
Lori M Wisely, MD
- Family Medicine Physician
- Tipton, IN
National Provider Identifier
1508856832
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 01042996A
- Practice address
- 1060 S Main St;
Suite 4
Tipton, IN 46072-8327 - Phone
- (765) 675-2069
- Fax
- (765) 675-7327
- NPI assigned
- Oct 27, 2005
- Sex
- Female
- 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 | 01042996A | IN | Primary |
Addresses
Primary practice location
1060 S Main St;
Suite 4
Tipton, IN 46072-8327
Mailing address
250 N Shadeland Ave
Indianapolis, IN 46219-4959
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200106590A | Medicaid | IN | |
| 200106590 | Medicaid | IN |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | lwisely@direct.iuhealth.org |
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 Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University Medical Diagnostic Associates, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Internal Medicine Physician
- Indianapolis, IN
- NPI 1861441537
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130371200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606262400000",
"number": "1508856832",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 N SHADELAND AVE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462194959"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1060 S MAIN ST;",
"address_2": "SUITE 4",
"city": "TIPTON",
"state": "IN",
"postal_code": "460728327",
"telephone_number": "765-675-2069",
"fax_number": "765-675-7327"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISELY",
"first_name": "LORI",
"middle_name": "M",
"name_prefix": "Mrs.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-10-27",
"last_updated": "2020-11-25",
"certification_date": "2020-11-25",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IN",
"license": "01042996A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200106590A",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200106590",
"state": "IN"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "lwisely@direct.iuhealth.org",
"affiliation": "N",
"address_1": "1060 S Main St;",
"address_2": "Suite 4",
"city": "Tipton",
"state": "IN",
"country_code": "US",
"postal_code": "460728327",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Tipton, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.