NPIMap

Individual provider Active NPI

Richard Lee Wiesemann II

  • Medical Physician Assistant
  • Coeur D Alene, ID
National Provider Identifier
1629220488
Registry record updated Apr 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA-2733 Issued in ID
Practice address
980 W Ironwood Dr Ste 104
Coeur D Alene, ID 83814-2668
Phone
(208) 667-0621
NPI assigned
Oct 10, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA-2733 ID Primary
Physician Assistant 363A00000X MT 543 MT

Addresses

Primary practice location

980 W Ironwood Dr Ste 104
Coeur D Alene, ID 83814-2668

Mailing address

1555 Liberty LN Ste C
Missoula, MT 59808-2001
Phone (406) 728-9545

Other practice location 1

700 W Ironwood Dr Ste 120
Coeur D Alene, ID 83814-4405
Phone (208) 625-3640

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT, ID2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20091209000159 MT Practitioner - Physician Assistant 1850430810 Reassigns benefits to 2 organizations
I20240625002177 ID Practitioner - Physician Assistant 1850430810 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kootenai Urgent Care LLCGroup PAC ID 1052441946, 19 clinicians
North Idaho Urology PLLCGroup PAC ID 1456452291, 9 clinicians

Practice addresses (Care Compare)

700 W Ironwood Dr
Suite 120E
Coeur D Alene, ID 83814-2656
Phone (208) 625-3640

980 W Ironwood Dr
Suite 104
Coeur D Alene, ID 83814-2668
Phone (208) 667-0621

Hospital & facility affiliations

  • Kootenai Health Hospital, Coeur D'Alene, ID, CCN 130049
  • Northwest Specialty Hospital Hospital, Post Falls, ID, CCN 130066
  • Bonner General Hospital Hospital, Sandpoint, ID, CCN 131328
  • Newport Community Hospital Hospital, Newport, WA, CCN 501310
  • Boundary Community Hospital Hospital, Bonners Ferry, ID, CCN 131301

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MT 543MTMDPhysician Assistant
PA-2733IDMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Marcus Daly Memorial Hospital Corporation CurrentSince Oct 1, 2016 Accepting new patients
Marcus Daly Memorial Hospital Corp CurrentSince Oct 1, 2016 Accepting new patients
Kootenai Urgent Care LLC Physician Assistant Past Accepting new patients
Kootenai Health, Inc. Physician Assistant PastSince Jul 21, 2024 Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients

Locations

1224 W Main St
Hamilton, MT 59840
Phone (406) 375-4823

1200 Westwood Dr
Hamilton, MT 59840
Phone (406) 363-2211

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 and National Provider Directory roles.

Hospital & facility affiliations 7

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": "1223596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775520000000",
    "number": "1629220488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 LIBERTY LN STE C",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598082001",
            "telephone_number": "406-728-9545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "980 W IRONWOOD DR STE 104",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142668",
            "telephone_number": "208-667-0621"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 W Ironwood Dr Ste 120",
            "address_purpose": "LOCATION",
            "city": "Coeur D Alene",
            "state": "ID",
            "postal_code": "838144405",
            "country_code": "US",
            "telephone_number": "208-625-3640",
            "fax_number": "208-625-3645",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIESEMANN",
        "first_name": "RICHARD",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "name_suffix": "II",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-10",
        "last_updated": "2026-04-07",
        "certification_date": "2026-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "PA-2733",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MT",
            "license": "MT 543",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coeur D Alene, ID

Sources for this page

Verify at the official NPI Registry.