Koa Wier

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95031900 Issued in CA

Practice address

999 N Tustin Ave Ste G1
Santa Ana, CA 92705-3528

Phone

(714) 545-5550

NPI assigned

Jun 5, 2019

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 CA

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

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bridge Telehealth PCGroup PAC ID 4082097613, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence St. Jude Medical Center Hospital, Fullerton, CA, CCN 050168

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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 and National Provider Directory roles.

• Bridge Telehealth PC

  • Psychiatry Physician
  • Fullerton, CA
  • NPI 1275266264
  Medicare reassignment Care Compare group NPD
• Market Pharmacy LLC

  • Community/Retail Pharmacy
  • Santa Ana, CA
  • NPI 1194405076
  NPD

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

• St Jude Hospital Inc

  • General Acute Care Hospital
  • Fullerton, CA
  • NPI 1194926279
  Care Compare affiliation
• St Jude Hospital Inc

  • General Acute Care Hospital
  • Brea, CA
  • NPI 1891904942
  Care Compare affiliation

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

{
    "created_epoch": "1559692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728000000000",
    "number": "1740848670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3151 AIRWAY AVE STE G1",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926264624",
            "telephone_number": "714-545-5550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "999 N TUSTIN AVE STE G1",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927053528",
            "telephone_number": "714-545-5550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIER",
        "first_name": "KOA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-05",
        "last_updated": "2024-10-04",
        "certification_date": "2024-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95031900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• George Le Whorton
• Mateo Widolff
• Vanessa Iliana Wiebach
• Wieler & Sein Medical Group
• Martin W. Wieler, M.D.
• Amanda Wiginton
• Conny Wijaya
• Wikoff Chiropractic, Inc.
• Brian Howard Wikoff, D.C.
• Scott Alan Wilchek, D.O.

• Psychiatric/Mental Health Nurse Practitioner in Santa Ana, CA
• Providers in Santa Ana, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2024; 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.