Chad A Wiesenauer, M.D.

Primary specialty

Pediatric Surgery PhysicianTaxonomy code 2086S0120X

License

01053500A Issued in IN

Practice address

234 E Gray St
Louisville, KY 40202-1900

Phone

(502) 588-0390

Fax

(502) 584-5437

NPI assigned

Apr 12, 2007

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IN

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: chad.wiesenauer.1@7598.direct.athenahealth.com

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.

• St Vincent Pediatric Subspecialties

  • Pediatrics Physician
  • Indianapolis, IN
  • NPI 1013967736

  Pediatric Surgery

  Medicare reassignment NPD
• St Vincent Pediatric Subspecialties

  • Pediatric Critical Care Medicine Physician
  • Evansville, IN
  • NPI 1851950224
  NPD

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507507200000",
    "number": "1861616732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "234 E GRAY ST",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021900",
            "telephone_number": "502-588-0390",
            "fax_number": "502-584-5437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "234 E GRAY ST",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021900",
            "telephone_number": "502-588-0390",
            "fax_number": "502-584-5437"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "234 E Gray St",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402021900",
            "country_code": "US",
            "telephone_number": "502-583-7337",
            "fax_number": "502-584-5437",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIESENAUER",
        "first_name": "CHAD",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-12",
        "last_updated": "2017-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "IN",
            "license": "01053500A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "01053500A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100008600",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Wieringa
• Maryann Wiese, LPCC-S
• Tanya A Wiese, D.O.
• Cheryl Ann Wiesemann
• Richard J. Wiesemann, M.D.
• Dawn Wietfeldt, DC
• Gretchen Anne Wigand, DMD
• Kelsey Elaine Wigand
• Thomas Louis Wigger, DMD
• Thomas Stewart Wigger, DMD

• Pediatric Surgery Physician in Louisville, KY
• Providers in Louisville, KY by specialty
• Pediatric Surgery Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.