Active NPI
Ronald E Wiisanen, MD
- Family Medicine Physician
- Fargo, ND
National Provider Identifier
1790794295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 4277
- Practice address
- 2400 32ND Ave S
Fargo, ND 58103-5800 - Phone
- (701) 234-8866
- NPI assigned
- Aug 5, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4277 | ND | Primary |
Addresses
Primary practice location
2400 32ND Ave S
Fargo, ND 58103-5800
Mailing address
2400 32ND Ave S
Fargo, ND 58103-5800
Phone (701) 234-8866
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22254 | Other | ND | ND BCBS |
| 22G06WI | Other | MN | MN BCBS |
| 1008280 | Other | PREFERREDONE | |
| 952383900 | Medicaid | MN | |
| 0109660 | Other | MEDICA | |
| 10404 | Medicaid | ND | |
| HP20680 | Other | HEALTHPARTNERS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4277 | ND | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323734400000",
"number": "1790794295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2400 32ND AVE S",
"city": "FARGO",
"state": "ND",
"postal_code": "581035800",
"telephone_number": "701-234-8866"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2400 32ND AVE S",
"city": "FARGO",
"state": "ND",
"postal_code": "581035800",
"telephone_number": "701-234-8866"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIISANEN",
"first_name": "RONALD",
"middle_name": "E",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-05",
"last_updated": "2011-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ND",
"license": "4277",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ND BCBS",
"identifier": "22254",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MN BCBS",
"identifier": "22G06WI",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERREDONE",
"identifier": "1008280",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "952383900",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "0109660",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10404",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS",
"identifier": "HP20680",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.