Individual provider Active NPI

Eileen S Wiesenberger, DO

  • Internal Medicine Physician
  • Eldersburg, MD
National Provider Identifier
1609919497
Registry record updated Dec 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
H0073247 Issued in MD
Practice address
6190 Georgetown Blvd
Eldersburg, MD 21784-6460
Phone
(410) 552-5050
NPI assigned
Feb 14, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 25, 2012

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X P18479 MD
Internal Medicine Physician 207R00000X OS 10334 FL
Internal Medicine Physician 207R00000X H0073247 MD Primary

Addresses

Primary practice location

6190 Georgetown Blvd
Eldersburg, MD 21784-6460

Mailing address

6190 Georgetown Blvd
Eldersburg, MD 21784-6460
Phone (410) 552-5050

Other identifiers 1

IdentifierTypeStateIssuer
000608200MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20101213000696 DC Practitioner - Internal Medicine 6204984974 Reassigns benefits to 1 organization
I20120124000770 MD Practitioner - Internal Medicine 6204984974 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Philadelphia College of Osteopathic Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Medstar Medical Group II LLCGroup PAC ID 0547413825, 3,726 clinicians

Practice addresses (Care Compare)

106 Irving St NW 4200
MMG at WHC
Washington, DC 20010-2979
Phone (202) 877-2200

6410 Rockledge Dr
Bethesda, MD 20817-1844

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.34 of 100Reported as group
Quality
67.9
Promoting interoperability
100
Improvement activities
40
Cost
69.47

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS 10334FLMDInternal Medicine Physician
P18479MDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medstar Medical Group II LLC CurrentSince Jul 16, 2018 Accepting new patients
Lifebridge Community Physicians, Inc Current Accepting new patients
Medstar Medical Group II LLC Internal Medicine CurrentSince Jul 16, 2018 Accepting new patients
Lifebridge Community Physicians, Inc Internal Medicine CurrentSince May 1, 2017 Accepting new patients
Lifebridge Community Physicians Inc CurrentSince May 1, 2017 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

1145 19th St NW
Ste 311
Washington, DC 20036
Phone (202) 429-2401

106 Irving St NW
Ste 4200
Washington, DC 20010
Phone (202) 877-2200

5601 Loch Raven Blvd
Ste 102
Baltimore, MD 21239
Phone (410) 581-1200

2435 W Belvedere Ave
Ste 56
Baltimore, MD 21215
Phone (410) 578-8632

18109 Prince Philip Dr
Ste B200
Olney, MD 20832
Phone (301) 260-3280

6190 Georgetown Blvd
Sykesville, MD 21784
Phone (410) 552-4235

410 Malcolm Dr
Ste A
Westminster, MD 21157
Phone (410) 876-1633

2000 15th St N
Ste 600
Arlington, VA 22201
Phone (202) 425-0000

Organizations & group practices 7

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 3

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": "1171411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1356393600000",
    "number": "1609919497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6190 GEORGETOWN BLVD",
            "city": "ELDERSBURG",
            "state": "MD",
            "postal_code": "217846460",
            "telephone_number": "410-552-5050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6190 GEORGETOWN BLVD",
            "city": "ELDERSBURG",
            "state": "MD",
            "postal_code": "217846460",
            "telephone_number": "410-552-5050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIESENBERGER",
        "first_name": "EILEEN",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-14",
        "last_updated": "2012-12-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "P18479",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "OS 10334",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "H0073247",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000608200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eldersburg, MD

Sources for this page

Verify at the official NPI Registry.