Christopher Paul Wiebusch, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

1920 Issued in WI

Practice address

N27W23953 Paul Rd
Ste. 206
Pewaukee, WI 53072-6242

Phone

(262) 347-0701

Fax

(262) 347-0705

NPI assigned

Apr 19, 2007

Last updated

Aug 3, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Agnesian Healthcare, Inc

  dba SSM Health St Agnes Hospital Fond Du Lac

  • General Acute Care Hospital
  • Fond Du Lac, WI
  • NPI 1346228541
  Medicare reassignment NPD
• Pediatric Neuropsychology and Treatment Associates, SC

  • Clinical Child & Adolescent Psychologist
  • Pewaukee, WI
  • NPI 1326265448

  Clinical Neuropsychologist

  NPD (past) Authorized official
• Wiebusch & Nicholson Center for Autism, Inc.

  • Community/Behavioral Health Agency
  • Pewaukee, WI
  • NPI 1407073505
  NPD (past) Authorized official
• Agnesian Healthcare Inc

  dba SSM Health Pharmacy

  • Community/Retail Pharmacy
  • Waupun, WI
  • NPI 1366417917
  NPD
• Agnesian Healthcare Inc

  dba SSM Health Fond Du Lac Regional Clinic

  • Family Medicine Physician
  • Fond Du Lac, WI
  • NPI 1730162991
  NPD
• Agnesian Healthcare Inc

  dba SSM Health Behavioral Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fond Du Lac, WI
  • NPI 1841320884
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627948800000",
    "number": "1659598746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N27W23953 PAUL RD",
            "address_2": "STE. 206",
            "city": "PEWAUKEE",
            "state": "WI",
            "postal_code": "530726242",
            "telephone_number": "262-347-0701",
            "fax_number": "262-347-0705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N27W23953 PAUL RD",
            "address_2": "STE. 206",
            "city": "PEWAUKEE",
            "state": "WI",
            "postal_code": "530726242",
            "telephone_number": "262-347-0701",
            "fax_number": "262-347-0705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIEBUSCH",
        "first_name": "CHRISTOPHER",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-19",
        "last_updated": "2021-08-03",
        "certification_date": "2021-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "WI",
            "license": "1920 057",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "1920",
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "WI",
            "license": "1920 057",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39126000",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "430 E Division St",
            "city": "Fond Du Lac",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549354560",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cwiebusch378374@direct-ehr-ssmhc.com",
            "affiliation": "Y",
            "affiliationName": "AGNESIAN HEALTHCARE INC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "cwiebusch378374@direct-ehr-ssmhc.com",
            "address_1": "430 E Division St",
            "city": "Fond Du Lac",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549354560",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kevin Wexler, D.C.
• Sarah Whiteside, MPT
• Stephanie L Whitt, M.D.
• Amy Lynn Wieber, D.D.S.
• Wiebusch & Nicholson Center for Autism, Inc.
• Jessica Helena Wieland, RN
• Nicole L Wierzbicki, PT
• Nicholas Wilcox, M.D.
• Danielle E Willey, PA-C
• Ryan Murphy Willging, PT

• Psychologist in Pewaukee, WI
• Providers in Pewaukee, WI by specialty
• Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.