Jerry Paul Wisdom III, CRNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1-152894 Issued in AL

Practice address

1450 Ross Clark Cir Ste 400
Dothan, AL 36301-4770

Phone

(334) 305-0400

NPI assigned

Jul 20, 2021

Sex

Male

Sole proprietor

No

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 AL

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

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern Clinic PCGroup PAC ID 1355329269, 25 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Southeast Health Medical Center Hospital, Dothan, AL, CCN 010001

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: twisdom@scpc.gwaydirect.com
• FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.1720

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.

• Southern Clinic PC

  • Internal Medicine Physician
  • Dothan, AL
  • NPI 1053410480
  Medicare reassignment Care Compare group NPD

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

• Houston County Healthcare Authority

  • General Acute Care Hospital
  • Dothan, AL
  • NPI 1164403861
  Care Compare affiliation

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

{
    "created_epoch": "1626739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626739200000",
    "number": "1912570607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 ROSS CLARK CIR STE 400",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363014770",
            "telephone_number": "334-305-0400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 ROSS CLARK CIR STE 400",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363014770",
            "telephone_number": "334-305-0400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISDOM",
        "first_name": "JERRY",
        "middle_name": "PAUL",
        "name_suffix": "III",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-20",
        "last_updated": "2021-07-20",
        "certification_date": "2021-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-152894",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wiregrass Wound & Amputation Prevention Center, LLC
• Wiregrass Wound & Amputation Prevention Center, LLC
• Wiregrass Wound Care Consultants LLC
• Wiregrass Wound Care LLC
• Wirewall Healthcare Distribution LLC
• Jessica Nicole Wisdom, CRNP
• Steven Dwayne Wise, M.D.
• Cindy Womack
• Shannon Richard Womack
• Women'S Healthcare of Dothan, PC

• Family Nurse Practitioner in Dothan, AL
• Providers in Dothan, AL by specialty
• Family Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2021; 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.