Christopher Lee Wistrom, D.O.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

57145-21 Issued in WI

Practice address

1000 Mineral Point Ave
Janesville, WI 53548-2940

Phone

(608) 756-6611

Fax

(608) 756-6177

NPI assigned

Jul 28, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI, IL2 enrollments

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 2

Specialty

Emergency Medicine

Education

At Still University of Health Sciences, College of Osteo Med, Kirksville, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mercy Health System CorporationGroup PAC ID 7416860440, shared by 14 NPIs, 749 clinicians

Freeport Memorial HospitalGroup PAC ID 8426958232, 168 clinicians

Rockford Health PhysiciansGroup PAC ID 2567374036, 520 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Javon Bea Hospital Hospital, Rockford, IL, CCN 140239
• Mercy Health System Corp Hospital, Janesville, WI, CCN 520066
• FHN Memorial Hospital Hospital, Freeport, IL, CCN 140160
• Mercy Walworth Hospital & Medical Center Hospital, Lake Geneva, WI, CCN 521357

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cwistrom25219@direct.mhemail.org

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.

• Freeport Memorial Hospital

  dba FHN-Memorial Hospital

  • General Acute Care Hospital
  • Freeport, IL
  • NPI 1447228788
  Medicare reassignment Care Compare group NPD
• Rockford Health Physicians

  dba Mercyhealth Physicians

  • Multi-Specialty Clinic/Center
  • Rockford, IL
  • NPI 1043242886
  Medicare reassignment Care Compare group NPD
• Mercy Health System Corporation

  dba MHS Physician Services

  • Multi-Specialty Clinic/Center
  • Janesville, WI
  • NPI 1598718603

  IL

  Medicare reassignment NPD
• Mercy Health System Corporation

  dba Mercy Walworth Hospital and Medical Center

  • Critical Access Hospital
  • Lake Geneva, WI
  • NPI 1699728550
  Medicare reassignment NPD
• Mercy Harvard Hospital Inc

  • Critical Access Hospital
  • Harvard, IL
  • NPI 1427001445
  Medicare reassignment NPD
• Mercy Health System Corporation

  dba Mercy Hospital Janesville

  • General Acute Care Hospital
  • Janesville, WI
  • NPI 1093768962
  NPD
• Mercy Harvard Hospital Inc

  dba Mercy Harvard Care Center

  • Skilled Nursing Facility
  • Harvard, IL
  • NPI 1124195557
  NPD
• Stoughton Hospital Association

  • Critical Access Hospital
  • Stoughton, WI
  • NPI 1679558647
  NPD (past)

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

• Mercy Health System Corporation

  dba Mercy Hospital Janesville

  • General Acute Care Hospital
  • Janesville, WI
  • NPI 1093768962
  Care Compare affiliation
• Mercy Health System Corporation

  dba Mercy Walworth Hospital and Medical Center

  • Critical Access Hospital
  • Lake Geneva, WI
  • NPI 1699728550
  Care Compare affiliation
• Freeport Memorial Hospital

  dba FHN-Memorial Hospital

  • General Acute Care Hospital
  • Freeport, IL
  • NPI 1447228788
  Care Compare affiliation
• Javon Bea Hospital

  • General Acute Care Hospital
  • Rockford, IL
  • NPI 1629118609
  Care Compare affiliation

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

{
    "created_epoch": "1217203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377129600000",
    "number": "1700041886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 MINERAL POINT AVE",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535482940",
            "telephone_number": "608-756-6611",
            "fax_number": "608-756-6177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 MINERAL POINT AVE",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535482940",
            "telephone_number": "608-756-6611",
            "fax_number": "608-756-6177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISTROM",
        "first_name": "CHRISTOPHER",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-28",
        "last_updated": "2013-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "5101017770",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "57145-21",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wisconsin CVS Pharmacy LLC (CVS Pharmacy #16257)
• Wisconsin CVS Pharmacy LLC (CVS Pharmacy # 08551)
• Wisconsin Dental Group, S.C. (ForwardDental Janesville)
• Wisconsin Endodontics SC (Endodontic Specialists of Wisconsin - Janesville)
• Wisconsin Vision, LLC
• Mary K Wolf, LCSW
• Morgen Wolf, L.AC.
• Theresa Wolfe
• Kenneth M Wolnak, DO
• Daniel Wong, DDS

• Emergency Medicine Physician in Janesville, WI
• Providers in Janesville, WI by specialty
• Emergency Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2013; 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.