Individual provider Active NPI

John S Wisda, MD

  • Emergency Medicine Physician
  • Huntsville, AL
National Provider Identifier
1912091216
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
00011713 Issued in AL
Practice address
1 Hospital Dr SW
Huntsville, AL 35801-6455
Phone
(256) 880-4177
Fax
(256) 880-4507
NPI assigned
Oct 3, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 00011713 AL Primary

Addresses

Primary practice location

1 Hospital Dr SW
Huntsville, AL 35801-6455

Mailing address

8678 Edgehill Dr SE
Huntsville, AL 35802-3786
Phone (256) 880-4177

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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

Enrollment IDStateProvider typePAC IDDetails
I20110214000768 AL Practitioner - Emergency Medicine 2365571452 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Georgetown University School of Medicine, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Crestwood HB Medical Services LLCGroup PAC ID 2163876491, 48 clinicians

Practice addresses (Care Compare)

1 Hospital Dr SW
Huntsville, AL 35801-6455
Phone (256) 429-4000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
41.83 of 100Reported as group
Quality
3.95
Improvement activities
40
Cost
82.18

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
00011713ALMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Crestwood HB Medical Services LLC Emergency Medicine CurrentSince Oct 1, 2023 Accepting new patients
App of Alabama Ed PLLC Emergency Medicine CurrentSince Mar 1, 2023 Accepting new patients

Locations

4370 W Main St
Dothan, AL 36305
Phone (256) 332-1611

1 Hospital Dr SW
Huntsville, AL 35801
Phone (256) 429-4000

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1912091216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8678 EDGEHILL DR SE",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358023786",
            "telephone_number": "256-880-4177",
            "fax_number": "256-880-4507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 HOSPITAL DR SW",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358016455",
            "telephone_number": "256-880-4177",
            "fax_number": "256-880-4507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISDA",
        "first_name": "JOHN",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AL",
            "license": "00011713",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntsville, AL

Sources for this page

Verify at the official NPI Registry.