DR. KRISTINE ELIZABETH WIESE (M.D.) – Forensic Psychiatry Physician, NPI 1073535977

DR. KRISTINE ELIZABETH WIESE (M.D.) is a healthcare provider. based in Roseville, Minnesota. specializing in Forensic Psychiatry Physician. They hold the professional credentials M.D.. They hold a License No. 39360 (MN). The NPI Number for DR. KRISTINE ELIZABETH WIESE (M.D.) is 1073535977

Main info

Female
Sole Proprietor
32 Years Of Experience
Accepts Medicare Assignment
Name
DR. KRISTINE ELIZABETH WIESE (M.D.)
NPI
1073535977
Phone
(612) 255-0628
Address
2277 HIGHWAY 36 W
Enumeration Date
23 July 2006
Last Update Date
21 July 2022

Doctor Profile

Medical School Name
RUSH MEDICAL COLLEGE OF RUSH UNIVERSITY
Secondary Phone
6122733000
Graduation Year
1994 (32 years ago)
PAC ID
3678552783
Group Practice PAC ID
1951213057
Professional Enrollment ID
I20040714000255
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience52
Completeness75
Years active:19State licenses:1Digital endpointsOther names

Provider Addresses for DR. KRISTINE ELIZABETH WIESE (M.D.)

  • 2277 HIGHWAY 36 W

    ROSEVILLE, MN 551133804

    Phone: (612) 255-0628

    Fax: (612) 255-0647

    Type: Location

  • Burnsville Post Office, 670, West Main Street, Burnsville, Yancey County, North Carolina, 28714, United States

    BURNSVILLE, MN 553370008

    Phone: (612) 670-1321

    Type: Mailing

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: 2004-07-14

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20040714000255IPsychiatryMNTBD

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.

Verify on CMS Revalidation Lookup Tool

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 55113)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1951213057View full group profile

Reviews

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Frequently asked questions

How do I look up DR. KRISTINE ELIZABETH WIESE (M.D.) by NPI?
Use NPI 1073535977 when you need to reference DR. KRISTINE ELIZABETH WIESE (M.D.) in forms, claims, or directories.
Is DR. KRISTINE ELIZABETH WIESE (M.D.) currently active in the NPI registry?
CMS-published data lists DR. KRISTINE ELIZABETH WIESE (M.D.) as an active registrant.
What field does DR. KRISTINE ELIZABETH WIESE (M.D.) work in?
You can think of DR. KRISTINE ELIZABETH WIESE (M.D.) as practicing within Forensic Psychiatry Physician. Clinical services aligned with this taxonomy classification.
What location shows for DR. KRISTINE ELIZABETH WIESE (M.D.)?
We surface Roseville, Minnesota for DR. KRISTINE ELIZABETH WIESE (M.D.) based on available NPPES addresses.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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