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AVA MARIE WIEDEMANN PA-C
NPI 1104469055
Physician Assistant in San Diego, CA

Active since October 23, 2019PECOS Enrolled
9665 CHESAPEAKE DR STE 350, SAN DIEGO, CA 92123(877) 260-2261 Get Directions Write a Review

NPPES record last updated: November 8, 2019. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Nov 8, 2019, Oct 23, 2019 (2 updates tracked since 2019).

About Ava Marie Wiedemann Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AVA MARIE WIEDEMANN PA-C (NPI 1104469055) is an individual physician assistant in San Diego, California, licensed in California (PA57411) and active in the NPI registry since October 2019. She is enrolled in Medicare PECOS and maintains a secondary practice location in El Segundo.

NPPES Registry Identity

NPI1104469055
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameAVA MARIE WIEDEMANNCredential: PA-C
Location Address9665 CHESAPEAKE DR STE 350San Diego, CA 92123-1352
Mailing Address2131 E Gretta PlPhoenix, AZ 85022-3436 · (602) 793-6456
Phone(877) 260-2261
Sole ProprietorNo
Enumeration DateOctober 23, 2019
Last NPPES UpdateNovember 8, 20192 updates tracked since enumeration
✔ NPI 1104469055 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in CA · PA57411
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
9665 CHESAPEAKE DR STE 350, San Diego, CA 92123
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Secondary Practice Location 1

Location 12101 Rosecrans Ave # 3230El Segundo, CA 90245-4749 · Phone (323) 628-8671

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ava Marie Wiedemann Pa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92123 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$94.87 typical visit price
range $62.10 – $184.71
Typical copayment $23.71 (range $15.52 – $46.17)
Most-billed visit code 99203
Established Patient
$76.87 typical visit price
range $20.62 – $151.42
Typical copayment $19.21 (range $5.15 – $37.85)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ACCENTCARE HOME HEALTH OF CALIFORNIA, INC.
Home Health
9665 CHESAPEAKE DR STE 350
SAN DIEGO, CA 92123
San Diego County (800) 765-7595
DANIEL WAYNE WEIR FNP-BC
Nurse Practitioner (Family)
9665 CHESAPEAKE DR STE 350
SAN DIEGO, CA 92123
San Diego County (657) 400-5180
EMILY ROSE WALTHER FNP
Nurse Practitioner
9665 CHESAPEAKE DR STE 350
SAN DIEGO, CA 92123
San Diego County (760) 975-1987

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ava Wiedemann's NPI number?

The NPI number for Ava Wiedemann is 1104469055. It was assigned to this individual provider in the NPPES registry on October 23, 2019.

Where is Ava Wiedemann located?

Ava Wiedemann practices at 9665 Chesapeake Dr Ste 350, San Diego, CA 92123. The listed phone number is (877) 260-2261.

What is Ava Wiedemann's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Ava Wiedemann enrolled in Medicare?

Yes. Ava Wiedemann is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Ava Wiedemann was last updated on November 8, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.