Individual provider Active NPI

Kristin Marie Wiese, M.D.

  • Pulmonary Disease Physician
  • Naperville, IL
National Provider Identifier
1619103280
Registry record updated Jun 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
036.130309 Issued in IL
Practice address
100 Spalding Dr Ste 102
Naperville, IL 60540-6551
Phone
(630) 871-6699
NPI assigned
Jun 9, 2009
Last updated
Jun 15, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125:056429 IL
Pulmonary Disease Physician 207RP1001X 036.130309 IL Primary

Addresses

Primary practice location

100 Spalding Dr Ste 102
Naperville, IL 60540-6551

Mailing address

PO Box 713260
Chicago, IL 60677-1260
Phone (630) 469-9200

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kwiese135736@direct.edward.org
Direct Messaging Address kwiese135736@dulyhealthandcare.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20120821000872 IL Practitioner - Pulmonary DiseasePractitioner - Internal MedicinePractitioner - Critical Care (Intensivists) 7810144128 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Critical Care (Intensivists), Internal Medicine
Education
Rush Medical College of Rush University, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Dupage Medical Group LTDGroup PAC ID 5496667941, 1,326 clinicians
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

100 Spalding Dr
Suite 102
Naperville, IL 60540-6551
Phone (630) 871-6699

155 E Brush Hill Rd
Elmhurst, IL 60126-5658
Phone (331) 221-0096

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125:056429ILMDInternal Medicine Physician
036.130309ILMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Edward Health Ventures CurrentSince Jul 1, 2023 Accepting new patients
Rush University Medical Group Internal Medicine CurrentSince Jul 1, 2012 Accepting new patients
Endeavor Health Medical Group CurrentSince Oct 15, 2012 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Jul 1, 2016 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Jul 1, 2016 Accepting new patients
Endeavor Health Medical Group Internal Medicine CurrentSince Oct 15, 2012 Accepting new patients
Dupage Medical Group LTD CurrentSince Aug 1, 2017 Accepting new patients
Dupage Medical Group LTD CurrentSince Aug 1, 2017 Accepting new patients
Edward Health Ventures CurrentSince Jul 1, 2023 Accepting new patients

Locations

30 Stratford Dr
Bloomingdale, IL 60108
Phone (630) 893-2210

Dept 5777
Carol Stream, IL 60122

1700 W Van Buren St
#500
Chicago, IL 60612
Phone (312) 563-2875

1860 Paysphere Cir
Chicago, IL 60674
Phone (630) 469-2000

75 Remittance Dr
Dept 1611
Chicago, IL 60675

9532 Eagle Way
Chicago, IL 60678

49 S Waukegan Rd
Ste 200
Deerfield, IL 60015
Phone (847) 945-4575

155 E Brush Hill Rd
Elmhurst, IL 60126
Phone (331) 221-3521

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

100 Spalding Dr
Ste 102
Naperville, IL 60540
Phone (630) 355-5860

120 Spalding Dr
Ste 101
Naperville, IL 60540
Phone (630) 527-7730

120 Spalding Dr
Ste 310
Naperville, IL 60540
Phone (630) 527-5575

801 S Washington St
Naperville, IL 60540
Phone (312) 355-0450

Interoperability endpoints

  • Direct secure messaging: kwiese135736@dulyhealthandcare.direct-ci.com

Organizations & group practices 9

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 2

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": "1244505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686787200000",
    "number": "1619103280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 713260",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606771260",
            "telephone_number": "630-469-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 SPALDING DR STE 102",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605406551",
            "telephone_number": "630-871-6699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIESE",
        "first_name": "KRISTIN",
        "middle_name": "MARIE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-09",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125:056429",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "IL",
            "license": "036.130309",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kwiese135736@direct.edward.org",
            "affiliation": "N",
            "address_1": "100 Spalding Dr Ste 102",
            "city": "Naperville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605406551",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kwiese135736@dulyhealthandcare.direct-ci.com",
            "affiliation": "N",
            "address_1": "100 Spalding Dr Ste 102",
            "city": "Naperville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605406551",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Naperville, IL

Sources for this page

Verify at the official NPI Registry.