Individual provider Active NPI

Kaitlyn Elaine Wieland, PA-C

  • Medical Physician Assistant
  • Leola, PA
National Provider Identifier
1801142864
Registry record updated Apr 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
MA055609 Issued in PA
Practice address
368 W Main St
Suite 100
Leola, PA 17540-1761
Phone
(717) 656-6122
Fax
(717) 656-0142
NPI assigned
Jul 27, 2012
Last updated
Apr 6, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X MA055609 PA Primary

Addresses

Primary practice location

368 W Main St
Suite 100
Leola, PA 17540-1761

Mailing address

3421 Concord Rd
York, PA 17402-9001
Phone (717) 656-6122

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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

Enrollment IDStateProvider typePAC IDDetails
I20120926000439 PA Practitioner - Physician Assistant 7113176793 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Wellspan Medical GroupGroup PAC ID 1951213115, 2,438 clinicians

Practice addresses (Care Compare)

25 Monument Rd
York, PA 17403-5073

2618 E Market St
Autumn House
York, PA 17403
Phone (717) 845-7214

368 W Main St
Leola, PA 17540-1761

914 W Market St
Autumn House West
York, PA 17403
Phone (717) 845-7214

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MA055609PAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wellspan Medical Group CurrentSince May 5, 2017 Accepting new patients
Wellspan Medical Group CurrentSince May 5, 2017 Accepting new patients
Southern Berks Family Medicine, PC Past Accepting new patients

Locations

175 Martin Ave
Ste 125
Ephrata, PA 17522
Phone (717) 812-4602

4131 Oregon Pike
#C
Ephrata, PA 17522

337 W Main St
Ste 100
Leola, PA 17540
Phone (717) 656-6122

368 W Main St
#100
Leola, PA 17540
Phone (717) 656-6122

1600 S George St
York, PA 17403
Phone (717) 848-3615

25 Monument Rd
Ste 270
York, PA 17403
Phone (717) 741-8250

3421 Concord Rd
York, PA 17402
Phone (717) 851-2441

Interoperability endpoints

  • Direct secure messaging: kwieland@direct-address.net
  • Direct secure messaging: kwieland60023@wellspan.direct-ci.com

Organizations & group practices 4

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": "1343347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680739200000",
    "number": "1801142864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3421 CONCORD RD",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174029001",
            "telephone_number": "717-656-6122",
            "fax_number": "717-656-0142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "368 W MAIN ST",
            "address_2": "SUITE 100",
            "city": "LEOLA",
            "state": "PA",
            "postal_code": "175401761",
            "telephone_number": "717-656-6122",
            "fax_number": "717-656-0142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIELAND",
        "first_name": "KAITLYN",
        "middle_name": "ELAINE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-27",
        "last_updated": "2023-04-06",
        "certification_date": "2023-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA055609",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leola, PA

Sources for this page

Verify at the official NPI Registry.