NPIMap

Individual provider Active NPI

Rebecca Wideman, FNP-C

  • Family Nurse Practitioner
  • Saint Clair Shores, MI
National Provider Identifier
1720438401
Registry record updated Dec 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704270250 Issued in MI
Practice address
29200 Harper Ave
Saint Clair Shores, MI 48081-1274
Phone
(586) 777-7577
NPI assigned
Jun 14, 2016
Last updated
Dec 12, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704270250 MI Primary

Addresses

Primary practice location

29200 Harper Ave
Saint Clair Shores, MI 48081-1274

Mailing address

29200 Harper Ave
Saint Clair Shores, MI 48081-1274
Phone (586) 777-7577

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rwideman353465@direct.beaumont.edu Health Information Exchange (HIE) Shores Rheumatology PC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20160922002872 MI Practitioner - Nurse Practitioner 1850687690 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Shores Rheumatology PCGroup PAC ID 3577596311, 6 clinicians

Practice addresses (Care Compare)

29200 Harper Ave
Saint Clair Shores, MI 48081-1274
Phone (586) 777-7577

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.47 of 100Reported as group
Quality
100
Promoting interoperability
100
Improvement activities
40
Cost
67.47

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Shores Rheumatology PC CurrentSince Sep 6, 2016 Accepting new patients

Locations

29200 Harper Ave
St Clr Shores, MI 48081
Phone (586) 777-7577

Interoperability endpoints

  • Direct secure messaging: rwideman1157525@direct.hfhs.org

Organizations & group practices 1

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 7

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": "1465862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607731200000",
    "number": "1720438401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29200 HARPER AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480811274",
            "telephone_number": "586-777-7577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29200 HARPER AVE",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480811274",
            "telephone_number": "586-777-7577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDEMAN",
        "first_name": "REBECCA",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-14",
        "last_updated": "2020-12-12",
        "certification_date": "2020-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704270250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rwideman353465@direct.beaumont.edu",
            "affiliation": "Y",
            "affiliationName": "Shores Rheumatology PC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "29200 Harper Ave",
            "city": "Saint Clair Shores",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480811274",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Clair Shores, MI

Sources for this page

Verify at the official NPI Registry.