NPIMap

Individual provider Active NPI

Robert R Wisner Jr., PA C

  • Physician Assistant
  • Galion, OH
National Provider Identifier
1902876154
Registry record updated Nov 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50001338 Issued in OH
Practice address
269 Portland Way S
Galion, OH 44833-2312
Phone
(419) 462-4560
Fax
(419) 462-4566
NPI assigned
Jan 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50001338 OH Primary

Addresses

Primary practice location

269 Portland Way S
Galion, OH 44833-2312

Mailing address

700 N Columbus St
Crestline, OH 44827-1455
Phone (419) 468-0522

Other identifiers 2

IdentifierTypeStateIssuer
H375510OtherOHMEDICARE
0083696MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rwisner482454@direct.osumc.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031217000479 OH Practitioner - Physician Assistant 5193622124 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Galion Community HospitalGroup PAC ID 5496737439, 40 clinicians

Practice addresses (Care Compare)

269 Portland Way S
Galion, OH 44833-2312

Hospital & facility affiliations

  • Avita Home Health and Hospice Home health agency, Galion, OH, CCN 367403
  • Galion Community Hospital Hospital, Galion, OH, CCN 361325
  • Bucyrus Community Hospital Hospital, Bucyrus, OH, CCN 361316
  • Avita Ontario Hospital, Ontario, OH, CCN 360365

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
50001338OHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Galion Community Hospital Physician Assistant CurrentSince Jul 1, 2005 Accepting new patients
Galion Community Hospital CurrentSince Jul 1, 2005 Accepting new patients
Emergency Medicine Physicians of Richland County, LTD Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

700 N Columbus St
Crestline, OH 44827
Phone (419) 462-3485

269 Portland Way S
Galion, OH 44833
Phone (419) 468-4841

955 Bucyrus Rd
Galion, OH 44833
Phone (419) 468-4220

270 Portland Way S
Galion, OH 44833
Phone (419) 468-7613

2981 W 4th St
Ontario, OH 44906
Phone (419) 468-0505

Organizations & group practices 5

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605657600000",
    "number": "1902876154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 N COLUMBUS ST",
            "city": "CRESTLINE",
            "state": "OH",
            "postal_code": "448271455",
            "telephone_number": "419-468-0522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "269 PORTLAND WAY S",
            "city": "GALION",
            "state": "OH",
            "postal_code": "448332312",
            "telephone_number": "419-462-4560",
            "fax_number": "419-462-4566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISNER",
        "first_name": "ROBERT",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-23",
        "last_updated": "2020-11-18",
        "certification_date": "2020-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50001338",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "H375510",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0083696",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rwisner482454@direct.osumc.edu",
            "affiliation": "N",
            "address_1": "269 Portland Way S",
            "city": "Galion",
            "state": "OH",
            "country_code": "US",
            "postal_code": "448332312",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Galion, OH

Sources for this page

Verify at the official NPI Registry.