Individual provider Active NPI

John D Wisneski, M.D.

  • Family Medicine Physician
  • Pagosa Springs, CO
National Provider Identifier
1982699039
Registry record updated Feb 16, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DR.0041986 Issued in CO
Practice address
95 S Pagosa Blvd
Pagosa Springs, CO 81147-8329
Phone
(970) 731-3700
Fax
(970) 731-3707
NPI assigned
Sep 14, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD20130017 NM
Family Medicine Physician 207Q00000X DR.0041986 CO Primary

Addresses

Primary practice location

95 S Pagosa Blvd
Pagosa Springs, CO 81147-8329

Mailing address

95 S Pagosa Blvd
Pagosa Springs, CO 81147-8329
Phone (970) 731-3700

Other identifiers 1

IdentifierTypeStateIssuer
075851211MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20040805001706 CO Practitioner - Family PracticePractitioner - General Practice 1355312844 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
95.74 of 100Reported as group
Quality
92.26
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD20130017NMMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Upper San Juan Health Service District Current Accepting new patients
Upper San Juan Health Service District CurrentSince Sep 3, 2015 Accepting new patients

Locations

95 S Pagosa Blvd
Pagosa Springs, CO 81147
Phone (970) 731-3700

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1126656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487203200000",
    "number": "1982699039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 S PAGOSA BLVD",
            "city": "PAGOSA SPRINGS",
            "state": "CO",
            "postal_code": "811478329",
            "telephone_number": "970-731-3700",
            "fax_number": "970-731-3707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 S PAGOSA BLVD",
            "city": "PAGOSA SPRINGS",
            "state": "CO",
            "postal_code": "811478329",
            "telephone_number": "970-731-3700",
            "fax_number": "970-731-3707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISNESKI",
        "first_name": "JOHN",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-14",
        "last_updated": "2017-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "MD20130017",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR.0041986",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "075851211",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pagosa Springs, CO

Sources for this page

Verify at the official NPI Registry.