Cody Elijah Wissenbach, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-2289 Issued in ID

Practice address

999 N Curtis Rd Ste 415
Boise, ID 83706-1334

Phone

(208) 302-2600

Fax

(208) 302-2625

NPI assigned

Feb 15, 2008

Last updated

Nov 14, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in FL, ID2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Saint Alphonsus Regional Medical Center IncGroup PAC ID 3476462359, 672 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cwissenbach3093803@direct.trinity-health.org
• Direct secure messaging: cwissenbach433375@direct.multicare.org

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.

• Saint Alphonsus Regional Medical Center Inc

  • Psychologist
  • Boise, ID
  • NPI 1649357716

  Physician Assistant

  Medicare reassignment Care Compare group NPD
• Primecare at Twin Lakes LLC

  • Urgent Care Clinic/Center
  • Daytona Beach, FL
  • NPI 1902809122
  Medicare reassignment
• Saint Alphonsus Regional Medical Center Inc

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1992736649
  NPD
• Saint Alphonsus Specialty Services Inc

  • Trauma Surgery Physician
  • Boise, ID
  • NPI 1093040479
  NPD (past)
• Atlantic Primary Care PLLC

  • Internal Medicine Physician
  • Port Orange, FL
  • NPI 1376167171
  NPD (past)
• Elmira Medical Urgent Care PLLC

  • Internal Medicine Physician
  • Elmira, NY
  • NPI 1033352372
  NPD (past)
• Grossmont Emergency Medical Group

  • Emergency Medicine Physician
  • La Mesa, CA
  • NPI 1861437501
  NPD (past)
• Rand Family Care LLC

  • Family Medicine Physician
  • Reno, NV
  • NPI 1912196189
  NPD (past)
• True North Health Navigation LLC

  dba Dispatch Health

  • Emergency Medicine Physician
  • Denver, CO
  • NPI 1740622133
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Saint Alphonsus Regional Medical Center Inc

  dba Saint Alphonsus RMC TVL

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1184155426
  Care Compare affiliation
• Saint Alphonsus Regional Medical Center Inc

  dba St Alphonsus Rehabilitation Services

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1457414948
  Care Compare affiliation
• Saint Alphonsus Regional Medical Center Inc

  • Psychiatric Hospital Unit
  • Boise, ID
  • NPI 1770687857
  Care Compare affiliation
• Saint Alphonsus Regional Medical Center Inc

  • Family Medicine Physician
  • Caldwell, ID
  • NPI 1861676298

  Hospital

  Care Compare affiliation
• Saint Alphonsus Regional Medical Center Inc

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1992736649
  Care Compare affiliation

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

{
    "created_epoch": "1203033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699920000000",
    "number": "1841468410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190930",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837190930",
            "telephone_number": "208-367-5170",
            "fax_number": "208-367-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "999 N CURTIS RD STE 415",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061334",
            "telephone_number": "208-302-2600",
            "fax_number": "208-302-2625"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6770 S McCarran Blvd",
            "address_purpose": "LOCATION",
            "city": "Reno",
            "state": "NV",
            "postal_code": "895096103",
            "country_code": "US",
            "telephone_number": "775-770-3254",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3841 W Charleston Blvd Ste 203",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891021858",
            "country_code": "US",
            "telephone_number": "702-848-4443",
            "fax_number": "702-805-0299",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1411 4th Ave",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981012249",
            "country_code": "US",
            "telephone_number": "253-271-9720",
            "fax_number": "253-212-3372",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WISSENBACH",
        "first_name": "CODY",
        "middle_name": "ELIJAH",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-02-15",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA1091",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-2289",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60720417",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aaron Wise
• Nancy Jane Wise
• Megan Kae Wiskirchen, M.S., CCC-SLP
• Rebecca S Wiskus, LMSW
• Jordan M Wisner, PHD
• Sydney Wiswell
• Emily Remington Withers, LMSW
• Erica Withrow
• Nancy Elizabeth Witman, FNP, MSN
• Emily T Witsil, L.M.T.

• Physician Assistant in Boise, ID
• Providers in Boise, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.