Jon D Wiese, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

ME54060 Issued in FL

Practice address

521 W State Road 434
Suite 301
Longwood, FL 32750-5166

Phone

(407) 767-5808

Fax

(407) 767-5892

NPI assigned

Nov 15, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Orlando Health Medical Group Inc

  • Internal Medicine Physician
  • Orlando, FL
  • NPI 1669429577
  Medicare reassignment NPD
• Jon D Wiese MD Facs PA

  • Surgery Physician
  • Longwood, FL
  • NPI 1902078512
  Authorized official Same address or phone
• Orlando Health Medical Group Inc

  • Durable Medical Equipment & Medical Supplies
  • Winter Park, FL
  • NPI 1265019541
  NPD

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479081600000",
    "number": "1952474561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "521 W STATE ROAD 434",
            "address_2": "SUITE 301",
            "city": "LONGWOOD",
            "state": "FL",
            "postal_code": "327505166",
            "telephone_number": "407-767-5808",
            "fax_number": "407-767-5892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 W STATE ROAD 434",
            "address_2": "SUITE 301",
            "city": "LONGWOOD",
            "state": "FL",
            "postal_code": "327505166",
            "telephone_number": "407-767-5808",
            "fax_number": "407-767-5892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIESE",
        "first_name": "JON",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-15",
        "last_updated": "2016-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "ME54060",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "ME54060",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "049597200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wheatland Health Medical Supply
• Christine Elizabeth White
• Jazmine Syril White
• Lauryn Ashley White, APRN
• Zackary Bryce Whitney, DO
• Cara Lynn Wiewiora, D.M.D.
• Tyler Wild
• Jenel Paeztold Wilhite
• Elizabeth Ann Wilkerson
• Brenda Sison Wilkinson, MD

• Surgery Physician in Longwood, FL
• Providers in Longwood, FL by specialty
• Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2016; 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.

Verify at the official NPI Registry.