DR. MARK ANDREW WISNER (D.O.) – Family Medicine Physician, NPI 1083829162
Family Medicine Physician
Main info
Doctor Profile
Contacts
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for DR. MARK ANDREW WISNER (D.O.)
5330 Manhattan Cir
Suite C-2
Boulder, CO 80303
Phone: (303) 543-1111
Fax: (303) 543-1112
Type: Location
214 South 4th Street
Kremmling, CO 804590399
Phone: (970) 887-5800
Type: Location
214, South 4th Street, Kremmling, Grand County, Colorado, 80459, United States
KREMMLING, CO 804590399
Phone: (970) 887-5800
Type: Location
Kremmling Library, 300, Grand Avenue, Kremmling, Grand County, Colorado, 80459, United States
KREMMLING, CO 804590399
Phone: (970) 887-5800
Type: Mailing
1109 FORD ST
GOLDEN, CO 804011176
Phone: (303) 277-2138
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 3 Open Payments records for all available years, with a total value of $48.
Total Amount is formed as General ($48) + Research ($0) + Ownership ($0) = $48.
Last reported payment date: 2024-03-13 • Largest payer in this snapshot: Exact Sciences Corporation ($22).
Total Amount
$48
General + Research + Ownership
Payments
3
Total payment records
General Amount
$48
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-03-13
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Exact Sciences Corporation | $22 |
| CooperSurgical, Inc. | $14 |
| ABBVIE INC. | $13 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2007-09-20
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20070920000825 | I | Family Practice | CO | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 80303)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | CO | |
| Nurse Practitioner | CO | |
| Family Practice | KS | |
| Physician Assistant | CO | |
| Family Practice | CO | |
| Nurse Practitioner | CO | |
| - | TX | |
| H O S P I T A L I S T | CO | |
| Nurse Practitioner | CO | |
| N E U R O S U R G E R Y | TX |
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