Lisa M Wiedel, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

ME110534 Issued in FL

Practice address

450 State Road 13
Ste 106-128
Saint Johns, FL 32259-3860

Phone

(904) 616-8410

NPI assigned

Mar 8, 2006

Last updated

Mar 7, 2013By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL, TN2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

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.

• Flagler OB GYN PA

  • Specialist
  • St Augustine, FL
  • NPI 1598910606

  Obstetrics & Gynecology

  Medicare reassignment NPD
• Halifax Healthcare Systems Inc

  dba HHCSI Halifax Family Health Center

  • Family Medicine Physician
  • Daytona Beach, FL
  • NPI 1245283530

  Obstetrics & Gynecology

  Medicare reassignment NPD
• OB Hospitalist Group LLC

  • Obstetrics & Gynecology Physician
  • Boca Raton, FL
  • NPI 1710647334
  Medicare reassignment NPD
• Obhg Tennessee, P.C.

  • Obstetrics & Gynecology Physician
  • Jackson, TN
  • NPI 1285924977
  Medicare reassignment NPD
• University of Tennessee

  • Family Medicine Physician
  • Jackson, TN
  • NPI 1780686436
  Medicare reassignment NPD
• WT Medical Associates

  • Internal Medicine Physician
  • Dyersburg, TN
  • NPI 1295223279
  Medicare reassignment NPD
• OB Hospitalist Group LLC

  • Obstetrics & Gynecology Physician
  • Melbourne, FL
  • NPI 1245472661
  NPD
• OB Hospitalist Group LLC

  • Obstetrics & Gynecology Physician
  • Winter Haven, FL
  • NPI 1851282016
  NPD
• University of Tennessee

  dba Univ. of TN Health Science Center College of Nursing

  • Family Nurse Practitioner
  • Memphis, TN
  • NPI 1174221337
  NPD
• WT Medical Associates

  dba West Tennessee Medical Group Primary Care Halls

  • Rural Health Clinic/Center
  • Halls, TN
  • NPI 1356176556
  NPD
• WT Medical Associates

  dba West Tennessee Medical Group Primary Care & Women's Health

  • Rural Health Clinic/Center
  • Dyersburg, TN
  • NPI 1427604198
  NPD
• WT University Medical Associates Inc

  dba West Tennessee Medical Group UT Medicine

  • Family Medicine Physician
  • Jackson, TN
  • NPI 1023572344

  Obstetrics & Gynecology

  NPD

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

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362614400000",
    "number": "1831166966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 STATE ROAD 13",
            "address_2": "STE 106-128",
            "city": "SAINT JOHNS",
            "state": "FL",
            "postal_code": "322593860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 STATE ROAD 13",
            "address_2": "STE 106-128",
            "city": "SAINT JOHNS",
            "state": "FL",
            "postal_code": "322593860",
            "telephone_number": "904-616-8410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIEDEL",
        "first_name": "LISA",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-03-08",
        "last_updated": "2013-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "OK",
            "license": "21690",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "FL",
            "license": "ME110534",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jami S Webster, M.D.
• Jessica Wein
• Harry David Weinstein, OD
• Donevan Westerveld, M.D.
• Amanda Whipple, BCBA
• Heather Wilkins
• Rachel Elizabeth Williams, BEHAVIOR TECHNICIAN
• Monica L Willis
• Willow Wellness Counseling
• Tony L. Willson, MD

• Obstetrics & Gynecology Physician in Saint Johns, FL
• Providers in Saint Johns, FL by specialty
• Obstetrics & Gynecology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2013; 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.