Active NPI
Andrew R. Wise, DDS
- Dentist
- Red Bluff, CA
National Provider Identifier
1811157373
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 45790
- Practice address
- 2540 Sister Mary Columba Dr
Red Bluff, CA 96080-4327 - Phone
- (530) 690-2778
- Fax
- (530) 690-2229
- NPI assigned
- Jun 9, 2008
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 45790 | CA | Primary |
Addresses
Primary practice location
2540 Sister Mary Columba Dr
Red Bluff, CA 96080-4327
Mailing address
2514 Warm Spring LN
Redding, CA 96003-6606
Phone (530) 339-6750
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150401001686 | TX | Order and Referring Only - Other (Physician) | 0941527949 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 45790 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northern Valley Indian Health, Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinic/Center
- Red Bluff, CA
- NPI 1588799449
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212969600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602633600000",
"number": "1811157373",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2514 WARM SPRING LN",
"city": "REDDING",
"state": "CA",
"postal_code": "960036606",
"telephone_number": "530-339-6750"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2540 SISTER MARY COLUMBA DR",
"city": "RED BLUFF",
"state": "CA",
"postal_code": "960804327",
"telephone_number": "530-690-2778",
"fax_number": "530-690-2229"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISE",
"first_name": "ANDREW",
"middle_name": "R.",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-06-09",
"last_updated": "2020-10-14",
"certification_date": "2020-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "45790",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Red Bluff, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 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.