Kim Keith Wiese, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085.006503 Issued in IL

Practice address

1524 W Glen Ave
Peoria, IL 61614-4692

Phone

(309) 512-0902

Fax

(094) 030-3973

NPI assigned

Jan 24, 2006

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 IL

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

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kim.wiese.1@14940.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.

• Norman Regional Hospital Authority

  • General Acute Care Hospital
  • Norman, OK
  • NPI 1700882578
  NPD (past)
• Norman Regional Sports & Occupational Medicin

  • Occupational Medicine Physician
  • Norman, OK
  • NPI 1598847337
  NPD (past)

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

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589846400000",
    "number": "1801866744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1524 W GLEN AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144692",
            "telephone_number": "309-512-0902",
            "fax_number": "309-403-0397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1524 W GLEN AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144692",
            "telephone_number": "309-512-0902",
            "fax_number": "094-030-3973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIESE",
        "first_name": "KIM",
        "middle_name": "KEITH",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-24",
        "last_updated": "2020-05-19",
        "certification_date": "2020-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.006503",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ladona Rae Wiebler, M.S.
• Owyn Wiegand
• Stephanie H Wieland, APN
• Cheryl M Wiemer, NP
• Nancy E. Wiemers, CNS
• Rebecca Wigant, APN
• Andrew Wiggers, PT
• Christine Ann Wigginton, MD
• Lori M Wight, D.C.
• Pamela Anne Wilcoxen-Rose, D.C.

• Physician Assistant in Peoria, IL
• Providers in Peoria, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.