Theron J Wiese, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA184738 Issued in OR

Practice address

1395 Commercial St SE
Salem, OR 97302-4205

Phone

(503) 990-7187

NPI assigned

May 31, 2016

Sex

Male

Sole proprietor

Yes

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 OR

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

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Salem Sleep Medicine PCGroup PAC ID 7517155047, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Salem Sleep Medicine, PC

  • Sleep Medicine (Internal Medicine) Physician
  • Salem, OR
  • NPI 1578873097
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1464652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508803200000",
    "number": "1841648862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6108 SW 18TH DR APT 9",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972391951",
            "telephone_number": "971-344-9996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1395 COMMERCIAL ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024205",
            "telephone_number": "503-990-7187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIESE",
        "first_name": "THERON",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-05-31",
        "last_updated": "2017-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA184738",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wholehearted Counseling LLC (Heart Space)
• Sonya M Whynot
• Shane C. Wibel, ATC
• Amber Wichman
• Adrienne Marie Wiens, LMFT
• Jeff Allan Wiesinger, CHW
• Brittney Diane Wiggins, M.A
• Ebony Dechelle Wiggins
• Amanda Michele Wilcox, QMHA
• Amber Wilcox, CMA

• Medical Physician Assistant in Salem, OR
• Providers in Salem, OR by specialty
• Medical Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2017; 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.