Individual provider Active NPI

Paul Edward Wise, MD

  • Colon & Rectal Surgery Physician
  • Saint Louis, MO
National Provider Identifier
1619076056
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X
License
2012011934 Issued in MO
Practice address
4500 Forest Park Ave
Div Surg Colon/Rectal, 5TH FL
Saint Louis, MO 63108-2114
Phone
(314) 454-7177
Fax
(888) 425-7946
NPI assigned
Sep 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 2012011934 MO
Colon & Rectal Surgery Physician 208C00000X 2012011934 MO Primary

Addresses

Primary practice location

4500 Forest Park Ave
Div Surg Colon/Rectal, 5TH FL
Saint Louis, MO 63108-2114

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 454-7177

Other identifiers 1

IdentifierTypeStateIssuer
209625003MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20120803000718 MO Practitioner - Colorectal Surgery (Proctology)Practitioner - General Surgery 6901880699 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Colorectal Surgery (Proctology)Also: General Surgery
Education
Johns Hopkins University School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Washington UniversityGroup PAC ID 9830008770, 2,968 clinicians

Practice addresses (Care Compare)

10 Barnes W Dr
West County Center
St Louis, MO 63141-6300
Phone (314) 996-8270

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.2 of 100Reported as group
Quality
71.6
Promoting interoperability
100
Improvement activities
40
Cost
75.75

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy33
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University CurrentSince Aug 1, 2012 Accepting new patients
Washington University CurrentSince Aug 1, 2012 Accepting new patients
Barnes Jewish Hospital Past Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

4921 Parkview Pl
Ste 8C
Saint Louis, MO 63110
Phone (314) 454-8877

4921 Parkview Pl
Ste 12B
Saint Louis, MO 63110
Phone (314) 747-9889

4500 Forest Park Ave
Fl 5
Saint Louis, MO 63108

1 Barnes Hospital Plz
Saint Louis, MO 63110
Phone (314) 362-9170

10 Barnes West Dr
Saint Louis, MO 63141
Phone (314) 996-3403

4921 Parkview Pl
Saint Louis, MO 63110
Phone (314) 747-4850

660 S Euclid Ave
Saint Louis, MO 63110

660 S Euclid Ave
#C
Saint Louis, MO 63110

660 S Euclid Ave
#8109
Saint Louis, MO 63110
Phone (314) 362-7841

4921 Parkview Pl
Ste 12C
Saint Louis, MO 63110
Phone (314) 454-8877

Interoperability endpoints

  • Direct secure messaging: pwise154705@direct.carenet.org
  • FHIR API: https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

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 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": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1619076056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "314-454-7177",
            "fax_number": "888-425-7946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 FOREST PARK AVE",
            "address_2": "DIV SURG COLON/RECTAL, 5TH FL",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631082114",
            "telephone_number": "314-454-7177",
            "fax_number": "888-425-7946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISE",
        "first_name": "PAUL",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-22",
        "last_updated": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MO",
            "license": "2012011934",
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "MO",
            "license": "2012011934",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209625003",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "4500 Forest Park Ave",
            "address_2": "Div Surg Colon/Rectal, 5th Fl",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631082114",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.