Active NPI
Wendy Wismer, DO
- Pediatrics Physician
- Royal Oak, MI
National Provider Identifier
1952158065
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 5151016542APP24
- Practice address
- 3535 W 13 Mile Rd
Royal Oak, MI 48073-6770 - Phone
- (248) 551-3000
- Fax
- (248) 551-2032
- NPI assigned
- May 6, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 5151016542APP24 | MI | Primary |
Addresses
Primary practice location
3535 W 13 Mile Rd
Royal Oak, MI 48073-6770
Mailing address
3535 W 13 Mile Rd
Royal Oak, MI 48073-6770
Phone (248) 551-3000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240620002562 | MI | Order and Referring Only - Pediatric Medicine | 0143763979 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5151016542APP24 | MI | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1714953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715299200000",
"number": "1952158065",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3535 W 13 MILE RD",
"city": "ROYAL OAK",
"state": "MI",
"postal_code": "480736770",
"telephone_number": "248-551-3000",
"fax_number": "248-551-2032"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3535 W 13 MILE RD",
"city": "ROYAL OAK",
"state": "MI",
"postal_code": "480736770",
"telephone_number": "248-551-3000",
"fax_number": "248-551-2032"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISMER",
"first_name": "WENDY",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-05-06",
"last_updated": "2024-05-10",
"certification_date": "2024-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MI",
"license": "5151016542APP24",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Royal Oak, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2024; 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.