Kyle Michael Wiedemer, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

TC115 Issued in KY

Practice address

225 Hospital Dr Ste 110
Winchester, KY 40391-7624

Phone

(859) 737-6572

NPI assigned

Jun 3, 2020

Sex

Male

Sole proprietor

Yes

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 KY

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

Group practices

Clark Regional Physician Practices LLCGroup PAC ID 9739337569, 46 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Clark Regional Medical Center Hospital, Winchester, KY, CCN 180092

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kyle.wiedemer.1@19475.direct.athenahealth.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.

• Clark Regional Physician Practices LLC

  • Rural Health Clinic/Center
  • Mt Sterling, KY
  • NPI 1780356253
  Medicare reassignment Care Compare group NPD
• Kentucky Mso LLC

  • Gastroenterology Physician
  • Georgetown, KY
  • NPI 1164867883
  Medicare reassignment
• Clark Regional Physician Practices LLC

  • Rural Health Clinic/Center
  • Winchester, KY
  • NPI 1831852771
  NPD
• Clark Regional Physician Practices LLC

  • Rural Health Clinic/Center
  • Winchester, KY
  • NPI 1841953783
  NPD
• Kentucky Mso LLC

  • Hematology & Oncology Physician
  • Georgetown, KY
  • NPI 1336483957

  Physician Assistant

  NPD
• Kentucky Mso LLC

  • Rural Health Clinic/Center
  • Lawrenceburg, KY
  • NPI 1922860758
  NPD
• Kentucky Hospital, LLC

  • General Acute Care Hospital
  • Winchester, KY
  • NPI 1811213994
  NPD (past)

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

• Kentucky Hospital, LLC

  • General Acute Care Hospital
  • Winchester, KY
  • NPI 1811213994
  Care Compare affiliation

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

{
    "created_epoch": "1591142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635811200000",
    "number": "1750905972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 HOSPITAL DR STE 110",
            "city": "WINCHESTER",
            "state": "KY",
            "postal_code": "403917624",
            "telephone_number": "859-737-6572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 HOSPITAL DR STE 110",
            "city": "WINCHESTER",
            "state": "KY",
            "postal_code": "403917624",
            "telephone_number": "859-737-6572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIEDEMER",
        "first_name": "KYLE",
        "middle_name": "MICHAEL",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-06-03",
        "last_updated": "2021-11-02",
        "certification_date": "2021-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "TC115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Amy Wood Williams, RD, LD
• Gabriel M Williams, DC
• Perry N Williams II, D.C.

• Physician Assistant in Winchester, KY
• Providers in Winchester, KY by specialty
• Physician Assistant in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2021; 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.