Teresa J Wiersma, NP - Medicare Nurse Practitioner in Randolph, WI

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Teresa J Wiersma, NP is a medicare enrolled "Nurse Practitioner - Family" in Randolph, Wisconsin. She graduated from nursing school in 2004 and has 20 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Randolph Community Clinic Sc and her current practice location is 504 S High St, Randolph, Wisconsin. You can reach out to her office (for appointments etc.) via phone at (920) 326-5060.

Teresa J Wiersma is licensed to practice in Wisconsin (license number 125502) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1417931833.

Contact Information

Teresa J Wiersma, NP
504 S High St,
Randolph, WI 53956-1499
(920) 326-5060
Not Available

Map and Direction




Provider's Profile

Full NameTeresa J Wiersma
GenderFemale
SpecialityNurse Practitioner
Experience20 Years
Location504 S High St, Randolph, Wisconsin
Accepts Medicare AssignmentsYes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Teresa J Wiersma graduated from nursing school in 2004
  NPI Data:
  • NPI Number: 1417931833
  • Provider Enumeration Date: 11/30/2005
  • Last Update Date: 09/15/2016
  Medicare PECOS Information:
  • PECOS PAC ID: 7618925546
  • Enrollment ID: I20050107000400

Medical Identifiers

Medical identifiers for Teresa J Wiersma such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1417931833NPI-NPPES
390807236CWOtherWIUNITY
WI01S5OtherWIJOHN DEERE
41253300MedicaidWI
P00206887OtherWIRAILROAD MEDICARE
13789OtherWIDEAN

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363LF0000XNurse Practitioner - Family 125502 (Wisconsin)Primary

Medical Facilities Affiliation

Facility NameLocationFacility Type
Beaver Dam Community Hospital Dba Marshfield Medical Center - Beaver DamBeaver dam, WIHospital
Columbus Community HospitalColumbus, WIHospital
Waupun Memorial HospitalWaupun, WIHospital

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Randolph Community Clinic Sc14562473113

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. Teresa J Wiersma allows following entities to bill medicare on her behalf.
Entity NameDivine Savior Healthcare Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1124083894
PECOS PAC ID: 5799684007
Enrollment ID: O20040225000909
Entity NameRandolph Community Clinic Sc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1497832257
PECOS PAC ID: 1456247311
Enrollment ID: O20101021000632

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. Teresa J Wiersma 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
Teresa J Wiersma, NP
504 S High St, Po Box 101,
Randolph, WI 53956-1499

Ph: (920) 326-5060		Teresa J Wiersma, NP
504 S High St,
Randolph, WI 53956-1499

Ph: (920) 326-5060

Reviews and Comments


Nurse Practitioner Nurses in Randolph, WI

Shannon N Sandstrom, NP
Nurse Practitioner
Medicare: Medicare Enrolled
Practice Location: 137 Cambria St, Randolph, WI 53956
Phone: 920-326-5303    

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.