NPIMap

Individual provider Active NPI

Wyatt Isaac Wiedenfeld, DPM

  • Podiatrist
  • Oconto Falls, WI
National Provider Identifier
1912310152
Registry record updated Apr 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
5901002524 Issued in MI
Practice address
853 S Main St
Oconto Falls, WI 54154-1203
Phone
(920) 496-4700
NPI assigned
Jun 5, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 5901002524 MI Primary

Addresses

Primary practice location

853 S Main St
Oconto Falls, WI 54154-1203

Mailing address

853 S Main St
Ste a
Oconto Falls, WI 54154-1212
Phone (920) 496-4700

Other practice location 1

29829 Telegraph Rd Ste 202
Southfield, MI 48034-7656
Phone (248) 258-0001

Other practice location 2

16001 W 9 Mile Rd
Southfield, MI 48075-4818
Phone (248) 849-3403

Other practice location 3

26850 Providence Pkwy Ste 502
Novi, MI 48374-1267
Phone (248) 662-4350

Other practice location 4

37595 7 Mile Rd Ste 370
Livonia, MI 48152-1003
Phone (248) 258-0001

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20180731001170 WI Practitioner - Podiatry 1557651601 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

853 S Main St
Oconto Falls, WI 54154-1203
Phone (920) 496-4700

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
94.81 of 100Reported as apm
Quality
85.98
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of nail tissue16

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Aug 20, 2018 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis CurrentSince Aug 20, 2018 Accepting new patients
St Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Aug 20, 2018 Accepting new patients
St. Nicholas Hospital-Sisters of the Third Order of St Francis CurrentSince Aug 20, 2018 Accepting new patients
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Past Accepting new patients

Locations

835 S Van Buren St
Green Bay, WI 54301
Phone (888) 901-7246

2793 Lineville Rd
Howard, WI 54313

853 S Main St
Ste A
Oconto Falls, WI 54154
Phone (920) 433-8448

855 S Main St
Ste 1
Oconto Falls, WI 54154
Phone (920) 846-8187

853 S Main St
Oconto Falls, WI 54154
Phone (920) 848-6346

3100 Superior Ave
Sheboygan, WI 53081
Phone (800) 472-6710

Organizations & group practices 6

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 9

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": "1401926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555977600000",
    "number": "1912310152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "853 S MAIN ST",
            "address_2": "STE A",
            "city": "OCONTO FALLS",
            "state": "WI",
            "postal_code": "541541212",
            "telephone_number": "920-496-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "853 S MAIN ST",
            "city": "OCONTO FALLS",
            "state": "WI",
            "postal_code": "541541203",
            "telephone_number": "920-496-4700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "29829 Telegraph Rd Ste 202",
            "address_purpose": "LOCATION",
            "city": "Southfield",
            "state": "MI",
            "postal_code": "480347656",
            "country_code": "US",
            "telephone_number": "248-258-0001",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16001 W 9 Mile Rd",
            "address_purpose": "LOCATION",
            "city": "Southfield",
            "state": "MI",
            "postal_code": "480754818",
            "country_code": "US",
            "telephone_number": "248-849-3403",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "26850 Providence Pkwy Ste 502",
            "address_purpose": "LOCATION",
            "city": "Novi",
            "state": "MI",
            "postal_code": "483741267",
            "country_code": "US",
            "telephone_number": "248-662-4350",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "37595 7 Mile Rd Ste 370",
            "address_purpose": "LOCATION",
            "city": "Livonia",
            "state": "MI",
            "postal_code": "481521003",
            "country_code": "US",
            "telephone_number": "248-258-0001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIEDENFELD",
        "first_name": "WYATT",
        "middle_name": "ISAAC",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-05",
        "last_updated": "2019-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "MI",
            "license": "5901002524",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oconto Falls, WI

Sources for this page

Verify at the official NPI Registry.