Dr Charles Wisniewski, DO - Medicare Psychiatry in Philadelphia, PA

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Dr Charles Wisniewski, DO is a medicare enrolled "Clinic/center - Adolescent And Children Mental Health" physician in Philadelphia, Pennsylvania. He went to Rutgers New Jersey Medical School and graduated in 2014 and has 10 years of diverse experience with area of expertise as Psychiatry. He is a member of the group practice Main Line Healthcare and his current practice location is 4641 Roosevelt Blvd, Philadelphia, Pennsylvania. You can reach out to his office (for appointments etc.) via phone at (215) 831-2600.

Dr Charles Wisniewski is licensed to practice in * (Not Available) (license number ) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1770997587.

Contact Information

Dr Charles Wisniewski, DO
4641 Roosevelt Blvd,
Philadelphia, PA 19124-2343
(215) 831-2600
Not Available

Map and Direction




Physician's Profile

Full NameDr Charles Wisniewski
GenderMale
SpecialityPsychiatry
Experience10 Years
Location4641 Roosevelt Blvd, Philadelphia, Pennsylvania
Accepts Medicare AssignmentsYes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Dr Charles Wisniewski attended and graduated from Rutgers New Jersey Medical School in 2014
  NPI Data:
  • NPI Number: 1770997587
  • Provider Enumeration Date: 06/19/2014
  • Last Update Date: 10/12/2018
  Medicare PECOS Information:
  • PECOS PAC ID: 8123382975
  • Enrollment ID: I20180503001229

Medical Identifiers

Medical identifiers for Dr Charles Wisniewski such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1770997587NPI-NPPES
1770997587MedicaidPA

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
2084P0800XPsychiatry & Neurology - Psychiatry OS019121 (Pennsylvania)Secondary
261QM0855XClinic/center - Adolescent And Children Mental Health (* (Not Available))Primary

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Main Line Healthcare1951215201907

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Charles Wisniewski allows following entities to bill medicare on his behalf.
Entity NameMain Line Healthcare
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1922077643
PECOS PAC ID: 1951215201
Enrollment ID: O20040308000373
Entity NameIntercommunity Action Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1730224445
PECOS PAC ID: 2961499579
Enrollment ID: O20040427000572
Entity NameEastern Pennsylvania Physician Alliance, Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1902440621
PECOS PAC ID: 8325478662
Enrollment ID: O20200428001935

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Charles Wisniewski is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Dr Charles Wisniewski, DO
4641 Roosevelt Blvd Ste E223,
Philadelphia, PA 19124-2343

Ph: (631) 831-4053		Dr Charles Wisniewski, DO
4641 Roosevelt Blvd,
Philadelphia, PA 19124-2343

Ph: (215) 831-2600

Reviews and Comments



Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.