Matthew Theodore Wieskamp

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

518 W Locust St
Davenport, IA 52803-2829

Phone

(563) 333-6000

NPI assigned

Sep 21, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Honorhealth Medical Group, LLCGroup PAC ID 1557274057, 338 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Honor Health John C. Lincoln Medical Center Hospital, Phoenix, AZ, CCN 030014

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mwieskamp569101@direct.honorhealth.com

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.

• Honorhealth Medical Group, LLC

  • Primary Care Clinic/Center
  • Peoria, AZ
  • NPI 1043851793
  Medicare reassignment Care Compare group
• Banner Primary Care Physicians Arizona LLC

  • Primary Care Clinic/Center
  • Phoenix, AZ
  • NPI 1659640902
  Medicare reassignment
• Banner Primary Care Physicians Arizona LLC

  • Primary Care Clinic/Center
  • Phoenix, AZ
  • NPI 1417238908
  NPD
• Banner Primary Care Physicians Arizona LLC

  • Primary Care Clinic/Center
  • Phoenix, AZ
  • NPI 1790306066
  NPD
• Honorhealth Medical Group, LLC

  • Internal Medicine Physician
  • Phoenix, AZ
  • NPI 1255442380
  NPD
• Honorhealth Medical Group, LLC

  • Family Medicine Physician
  • Scottsdale, AZ
  • NPI 1285338343
  NPD
• Honorhealth Medical Group, LLC

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1679876601
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Honorhealth

  • General Acute Care Hospital
  • Phoenix, AZ
  • NPI 1770690695
  Care Compare affiliation

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

{
    "created_epoch": "1600646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600646400000",
    "number": "1679189146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1678 TAYLOR AVE",
            "city": "MUSCATINE",
            "state": "IA",
            "postal_code": "527619789",
            "telephone_number": "563-506-8373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "518 W LOCUST ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528032829",
            "telephone_number": "563-333-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIESKAMP",
        "first_name": "MATTHEW",
        "middle_name": "THEODORE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-21",
        "last_updated": "2020-09-21",
        "certification_date": "2020-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wholistic Family Chiropractic LLC
• Thomas A. Wicks, D.C.
• Kari Elizabeth Wiese, OT
• Lindsay K Wiese, RD. LD
• Rebecca Andresen Wiese, MD
• Angela R Willi, LISW
• William Burke LTD
• William Burke LTD
• William Burke LTD
• William Burke LTD

• Physician Assistant in Davenport, IA
• Providers in Davenport, IA by specialty
• Physician Assistant in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.