Individual provider Active NPI

Michael B Wiese, M.D.

  • Orthopaedic Surgery Physician
  • Syracuse, NY
National Provider Identifier
1538137005
Registry record updated Dec 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
175162 Issued in NY
Practice address
5719 Widewaters Pkwy
Syracuse, NY 13214-1985
Phone
(315) 251-3100
Fax
(315) 449-9923
NPI assigned
Mar 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 175162 NY Primary

Addresses

Primary practice location

5719 Widewaters Pkwy
Syracuse, NY 13214-1985

Mailing address

PO Box 580
Syracuse, NY 13214-0580
Phone (315) 251-3140

Other identifiers 1

IdentifierTypeStateIssuer
01499807MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100310000697 NY Practitioner - Orthopedic Surgery 0547174161 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Georgetown University School of Medicine, 1985
Medicare assignment
May accept Medicare assignment
Group practices
Select PT, OT and SLP Rehabilitation Ny, PLLCGroup PAC ID 3870986656, 261 clinicians
Orthopedics East PCGroup PAC ID 3375512320, 2 clinicians

Practice addresses (Care Compare)

125 Harry Howard Ave
Hudson, NY 12534-1601
Phone (800) 479-7695

183 Intrepid LN
Syracuse, NY 13205-2548
Phone (315) 251-0401

5719 Widewaters Pkwy
Syracuse, NY 13214-1985
Phone (315) 251-3100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
0

Procedures performed for Medicare patients

ProcedureNumber of procedures
Knee replacement1-10
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
175162NYMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopedics East PC Orthopaedic Surgery CurrentSince Mar 1, 2003 Accepting new patients
Syracuse Orthopedic Specialists, PLLC Orthopaedic Surgery CurrentSince Dec 1, 2025 Accepting new patients
Crouse Medical Practice, PLLC Past Accepting new patients

Locations

736 Irving Ave
Syracuse, NY 13210
Phone (315) 470-7111

1001 W Fayette St
Ste 400
Syracuse, NY 13204
Phone (315) 472-1488

5719 Widewaters Pkwy
Syracuse, NY 13214
Phone (315) 251-3110

183 Intrepid Ln
Syracuse, NY 13205
Phone (315) 251-0401

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 4

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.

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": "1141948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764892800000",
    "number": "1538137005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 580",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132140580",
            "telephone_number": "315-251-3140",
            "fax_number": "315-552-6046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5719 WIDEWATERS PKWY",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132141985",
            "telephone_number": "315-251-3100",
            "fax_number": "315-449-9923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIESE",
        "first_name": "MICHAEL",
        "middle_name": "B",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-10",
        "last_updated": "2025-12-05",
        "certification_date": "2025-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NY",
            "license": "175162",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01499807",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.