Jordan Ann Wiedmann, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1174572 Issued in ND

Practice address

4040 42ND St S Ste N
Fargo, ND 58104-4352

Phone

(701) 543-5533

NPI assigned

Jun 29, 2020

Sex

Female

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 ND

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, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Foundations Mental Health Clinic PCGroup PAC ID 8921536996, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Foundations Mental Health Clinic, PC

  • Psychiatry Physician
  • Fargo, ND
  • NPI 1932922085
  Medicare reassignment Care Compare group Authorized official

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

{
    "created_epoch": "1593388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733270400000",
    "number": "1750908455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2822 2ND ST N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581021606",
            "telephone_number": "701-543-5533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4040 42ND ST S STE N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581044352",
            "telephone_number": "701-543-5533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIEDMANN",
        "first_name": "JORDAN",
        "middle_name": "ANN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-29",
        "last_updated": "2024-12-04",
        "certification_date": "2024-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ND",
            "license": "1174572",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Fahrenkrug Wicks, LMSW
• Megan Widmer
• Nicole Widmer
• Katyana Marie Wiedenman, MS
• Sara E Wiederholt, LCSW
• Lucy Wiedrich
• Shania Rose Wielenberg
• Taylor Wieler, LAPC
• Alyce A. Wiemken, MS, CCC/SLP
• Anna Rose Wiemken, NP

• Physician Assistant in Fargo, ND
• Providers in Fargo, ND by specialty
• Physician Assistant in North Dakota

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