Individual provider Active NPI

Patricia Diane Wise, PA

  • Physician Assistant
  • Bryan, OH
National Provider Identifier
1720388481
Registry record updated Jan 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.007054RX Issued in OH
Practice address
433 W High St
Bryan, OH 43506-1690
Phone
(419) 636-1131
Fax
(419) 636-3100
NPI assigned
Oct 28, 2010
Last updated
Jan 2, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2024

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 50.007054RX OH Primary

Addresses

Primary practice location

433 W High St
Bryan, OH 43506-1690

Mailing address

433 W High St
Bryan, OH 43506-1690
Phone (419) 636-1131

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV, OH, MI3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20140701001099 NV Practitioner - Physician Assistant 9032307137 Reassigns benefits to 1 organization
I20210908003152 OH Practitioner - Physician Assistant 9032307137 Reassigns benefits to 1 organization
I20241113001744 MI Practitioner - Physician Assistant 9032307137 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1456 Hudson Rd
Hillsdale, MI 49242-8314
Phone (517) 439-0200

168 S Howell St
Hillsdale, MI 49242-2040
Phone (517) 437-4451

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.81 of 100Reported as group
Quality
80.59
Promoting interoperability
100
Improvement activities
40
Cost
72.11

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4769AZMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Community Hospitals and Wellness Centers CurrentSince Sep 20, 2021 Accepting new patients
South Lyon Health Center, Inc. CurrentSince Jan 6, 2014 Accepting new patients
Community Hospitals and Wellness Centers CurrentSince Sep 20, 2021 Accepting new patients
South Lyon Health Center, Inc. CurrentSince Jan 6, 2014 Accepting new patients

Locations

213 S Whitacre St
Yerington, NV 89447
Phone (775) 463-2301

121 Westfield Dr
Archbold, OH 43502
Phone (419) 445-2015

433 W High St
Bryan, OH 43506
Phone (419) 636-1131

Interoperability endpoints

  • Direct secure messaging: pwise473380@direct.parkviewexchange.com

Organizations & group practices 6

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.

Hospital & facility affiliations 2

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": "1288224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704153600000",
    "number": "1720388481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "433 W HIGH ST",
            "city": "BRYAN",
            "state": "OH",
            "postal_code": "435061690",
            "telephone_number": "419-636-1131",
            "fax_number": "419-636-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 W HIGH ST",
            "city": "BRYAN",
            "state": "OH",
            "postal_code": "435061690",
            "telephone_number": "419-636-1131",
            "fax_number": "419-636-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISE",
        "first_name": "PATRICIA",
        "middle_name": "DIANE",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-28",
        "last_updated": "2024-01-02",
        "certification_date": "2024-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.007054RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bryan, OH

Sources for this page

Verify at the official NPI Registry.