JESSICA A. WIEDEMANN (NP) – Family Nurse Practitioner, NPI 1093256950
Family Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
8,192 NURSE PRACTITIONER in IN
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Provider Addresses for JESSICA A. WIEDEMANN (NP)
7601, West Jefferson Boulevard, Fort Wayne, Allen County, Indiana, 46804, United States
FORT WAYNE, IN 468044133
Phone: (260) 436-8686
Fax: (260) 436-8585
Type: Location
3926, New Vision Drive, Fort Wayne, Allen County, Indiana, 46845, United States
FORT WAYNE, IN 468451712
Phone: (260) 436-8686
Fax: (260) 436-8585
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 8 Open Payments records for all available years, with a total value of $333.
Total Amount is formed as General ($333) + Research ($0) + Ownership ($0) = $333.
Last reported payment date: 2024-10-04 • Largest payer in this snapshot: Spinal Simplicity, LLC ($208).
Total Amount
$333
General + Research + Ownership
Payments
8
Total payment records
General Amount
$333
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-04
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Spinal Simplicity, LLC | $208 |
| Collegium Pharmaceutical, Inc. | $49 |
| Lundbeck LLC | $45 |
| ABBVIE INC. | $16 |
| Antares Pharma, Inc. | $15 |
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: 2017-03-20
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 |
|---|---|---|---|---|
| I20170320000347 | I | Nurse Practitioner | IN | 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 | 40 | 40 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 36 | 36 | $0 |
| 73564 | X-ray of knee, 4 or more views | 27 | 27 | $0 |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 26 | 26 | $0 |
| 72100 | X-ray of lower and sacral spine, 2-3 views | 20 | 20 | $0 |
Insurance plans in this area (ZIP 46804)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | IN | |
| A N E S T H E S I O L O G Y | IN | |
| - | IN | |
| Nurse Practitioner | OH | |
| Nurse Practitioner | IN | |
| Physician Assistant | IN | |
| - | IN | |
| Physician Assistant | IN | |
| Physician Assistant | IN | |
| Physician Assistant | IN |
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