JOHN DAVID WISE (PA) – Physician Assistant, NPI 1093739724
Physician Assistant
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
5,035 PHYSICIAN ASSISTANT in IL
Provider Addresses for JOHN DAVID WISE (PA)
7501 Grand Ave
Gurnee, IL 600311551
Phone: (800) 323-8622
Fax: (224) 225-0389
Type: Location
PO box, Russell Road, Paoli, Tredyffrin Township, Chester County, Pennsylvania, 19301, United States
PREVEA HEALTH
GREEN BAY, WI 543079070
Phone: (920) 496-4700
Fax: (920) 496-4705
Type: Mailing
2793, Lineville Road, Suamico, Brown County, Wisconsin, 54313, United States
GREEN BAY, WI 543137152
Phone: (920) 496-4700
Fax: (920) 496-4705
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2024-05-08
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20040625000971 | I | Physician Assistant | WI | TBD |
| I20240508001273 | I | Physician Assistant | IL | 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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 21 | 21 | $0 |
Insurance plans in this area (ZIP 60031)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | WI | |
| - | WI | |
| Nurse Practitioner | WI | |
| Physical Therapist In Private Practice | WI | |
| - | WI | |
| - | WI | |
| O B S T E T R I C S/ G Y N E C O L O G Y | WI | |
| Nurse Practitioner | WA | |
| Certified Registered Nurse Anesthetist (Crna) | WI | |
| Physical Therapist In Private Practice | WI |
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