NPIMap

Individual provider Active NPI

Ethan Ron Wiesler, MD

  • Orthopaedic Hand Surgery Physician
  • Winston Salem, NC
National Provider Identifier
1538146147
Registry record updated Aug 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Hand Surgery PhysicianTaxonomy code 207XS0106X
License
96-00222 Issued in NC
Practice address
Medical Center Blvd
Winston Salem, NC 27157-0001
Phone
(336) 716-2255
Fax
(336) 716-8018
NPI assigned
Dec 23, 2005
Last updated
Aug 20, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 9600222 NC
Orthopaedic Hand Surgery Physician 207XS0106X 96-00222 NC Primary

Addresses

Primary practice location

Medical Center Blvd
Winston Salem, NC 27157-0001

Mailing address

PO Box 344
Winston Salem, NC 27102-0344
Phone (336) 716-2255

Other identifiers 9

IdentifierTypeStateIssuer
98579OtherMEDCOST
200043944OtherRR MEDICARE
36195OtherPARTNERS
1850002000MedicaidWV
126FFOtherBCBS
7122310OtherAETNA
89126FFMedicaidNC
2280373AOtherNCMEDCIARE
6402941MedicaidVA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080604000188 NC Practitioner - Hand SurgeryPractitioner - Orthopedic Surgery 0648340521 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hand SurgeryAlso: Orthopedic Surgery
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

131 Miller St
Winston Salem, NC 27103-2508
Phone (336) 716-2734

Medical Ctr Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-2734

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
96-00222NCMDOrthopaedic Hand Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest University Health Sciences CurrentSince Jul 1, 2002 Accepting new patients
Wake Forest Health Network, LLC CurrentSince Jan 23, 2016 Accepting new patients
Cornerstone Health Care, LLC Orthopaedic Surgery CurrentSince Jan 23, 2016 Accepting new patients
Wake Forest Health Network LLC Current Accepting new patients
Cornerstone Health Care PA Past Accepting new patients

Locations

1701 Westchester Dr
Ste 850
High Point, NC 27262
Phone (336) 802-2400

4515 Premier Dr
Ste 307
High Point, NC 27265
Phone (336) 802-2250

905 Phillips Ave
High Point, NC 27262
Phone (336) 802-2040

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

Interoperability endpoints

  • Direct secure messaging: ewiesler2754333@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 5

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 5

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": "1135296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597881600000",
    "number": "1538146147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 344",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271020344",
            "telephone_number": "336-716-2255",
            "fax_number": "336-716-8018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MEDICAL CENTER BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271570001",
            "telephone_number": "336-716-2255",
            "fax_number": "336-716-8018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIESLER",
        "first_name": "ETHAN",
        "middle_name": "RON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-23",
        "last_updated": "2020-08-20",
        "certification_date": "2020-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NC",
            "license": "9600222",
            "primary": false
        },
        {
            "code": "207XS0106X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": "NC",
            "license": "96-00222",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "98579",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "200043944",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS",
            "identifier": "36195",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1850002000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "126FF",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7122310",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89126FF",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCIARE",
            "identifier": "2280373A",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6402941",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.