NPIMap

Individual provider Active NPI

Erin Kathleen Wiesner, PA

  • Physician Assistant
  • Saint Louis, MO
National Provider Identifier
1639493372
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2010039476 Issued in MO
Practice address
400 S Kingshighway Blvd
Dept Emergency Med
Saint Louis, MO 63110-1014
Phone
(314) 362-9123
Fax
(314) 747-3338
NPI assigned
Mar 24, 2010
Last updated
Apr 17, 2025By the provider in NPPES
Sex
Female
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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2010039476 MO Primary

Addresses

Primary practice location

400 S Kingshighway Blvd
Dept Emergency Med
Saint Louis, MO 63110-1014

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 362-9123

Other identifiers 1

IdentifierTypeStateIssuer
220041145MedicaidMO

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
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120125000457 MO Practitioner - Physician Assistant 7315139284 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Oncology LLCGroup PAC ID 1153446471, 30 clinicians

Practice addresses (Care Compare)

15945 Clayton Rd
Suite 120
Ballwin, MO 63011-2490
Phone (636) 256-5000

607 S New Ballas Rd
Saint Louis, MO 63141-8219
Phone (314) 251-4400

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University CurrentSince May 24, 2017 Accepting new patients
SSM Health Care St Louis CurrentSince Dec 15, 2020 Accepting new patients
SSM Health Care St. Louis CurrentSince Dec 15, 2020 Accepting new patients
Cep America LLC CurrentSince Feb 3, 2020 Accepting new patients
Cep America LLC CurrentSince Feb 3, 2020 Accepting new patients
Washington University CurrentSince May 24, 2017 Accepting new patients
Sheridan Emergency Physician Services of Kansas, P.a. Past Accepting new patients
Missouri Em-I Medical Services, P.C. Physician Assistant Past Accepting new patients
Mercy Hospitals East Communities Past Accepting new patients
Little Blue Emergency Physicians LLC Past Accepting new patients
Blue Parkway Emergency Physicians, LLC PastSince Dec 15, 2019 Accepting new patients
Sheridan Emergency Physician Services of Kansas, PA Past Accepting new patients
Family Practice Associates CHTD Past Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 900-3125

7344 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-6189

1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000

100 Medical Plz
Lake St Louis, MO 63367
Phone (636) 625-5200

300 1st Capitol Dr
Saint Charles, MO 63301
Phone (636) 669-2211

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

400 S Kingshighway Blvd
Saint Louis, MO 63110
Phone (314) 454-7900

6420 Clayton Rd
Saint Louis, MO 63117
Phone (314) 768-8442

660 S Euclid Ave
#8072
Saint Louis, MO 63110
Phone (314) 362-9177

660 S Euclid Ave
#C
Saint Louis, MO 63110

Organizations & group practices 15

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.

View all 15

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": "1269388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1639493372",
    "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": "314-362-9123",
            "fax_number": "314-747-3338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S KINGSHIGHWAY BLVD",
            "address_2": "DEPT EMERGENCY MED",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101014",
            "telephone_number": "314-362-9123",
            "fax_number": "314-747-3338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIESNER",
        "first_name": "ERIN",
        "middle_name": "KATHLEEN",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-24",
        "last_updated": "2025-04-17",
        "certification_date": "2024-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2010039476",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "220041145",
            "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": "400 S Kingshighway Blvd",
            "address_2": "Dept Emergency Med",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631101014",
            "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.