NPIMap

Organization Active NPI

Wise Medical, Inc.

  • Family Medicine Physician
  • Walnut Creek, CA
National Provider Identifier
1811917693
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A95309 Issued in CA
Legal business name
WISE MEDICAL, INC.
Practice address
1150 Civic Dr
Suite 100
Walnut Creek, CA 94596-8241
Phone
(925) 935-3113
Fax
(925) 935-4482
NPI assigned
Jul 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Alphaeus Mansfield Wise, MDNPI 1265475628
Title
President
Phone
(925) 935-3113

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X A95309 CA Primary

Addresses

Primary practice location

1150 Civic Dr
Suite 100
Walnut Creek, CA 94596-8241

Mailing address

1150 Civic Dr
Suite 100
Walnut Creek, CA 94596-8241
Phone (925) 935-3113

Other names 1

  • Alphaeus Wise, MD Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060808000320 CA Part B Supplier - Clinic/Group Practice 7810990017 Receives reassigned benefits from 1 practitioner
Practice locations: Walnut Creek, CA

National Provider Directory

National Provider Directory

Locations

1150 Civic Dr
Ste 100
Walnut Creek, CA 94596
Phone (925) 935-3113

1181 Boulevard Way
Ste B
Walnut Creek, CA 94595
Phone (925) 934-7691

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811917693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 CIVIC DR",
            "address_2": "SUITE 100",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945968241",
            "telephone_number": "925-935-3113",
            "fax_number": "925-935-4482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 CIVIC DR",
            "address_2": "SUITE 100",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945968241",
            "telephone_number": "925-935-3113",
            "fax_number": "925-935-4482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISE MEDICAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WISE",
        "authorized_official_first_name": "ALPHAEUS",
        "authorized_official_middle_name": "MANSFIELD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "925-935-3113",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A95309",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alphaeus Wise, MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Walnut Creek, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.