Deanna M Wildes, RN, BSN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN077963 Issued in GA

Practice address

4750 Waters Avenue
Suite 500
Savannah, GA 31404-6261

Phone

(912) 352-8346

Fax

(912) 355-1414

NPI assigned

Sep 22, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Deanna M Mayberry Former name

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Savannah Vascular Institute, LLCGroup PAC ID 2769542075, 20 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

83.11 of 100Reported as group

Quality

51.32

Promoting interoperability

98

Improvement activities

40

Cost

79.36

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor on Science - Nursing, Nurse Practitioner, Registered Nurse

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: deanna.wildes.p1@direct.savannahvascular.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Savannah Vascular Institute, LLC

  • Vascular Surgery Physician
  • Savannah, GA
  • NPI 1184873390
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1316649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663027200000",
    "number": "1003199480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 116336",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303686336",
            "telephone_number": "912-352-8346",
            "fax_number": "912-355-1414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4750 WATERS AVENUE",
            "address_2": "SUITE 500",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314046261",
            "telephone_number": "912-352-8346",
            "fax_number": "912-355-1414"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "166 Memorial Dr",
            "address_purpose": "LOCATION",
            "city": "Jesup",
            "state": "GA",
            "postal_code": "315450101",
            "country_code": "US",
            "telephone_number": "912-352-8346",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "104 Charles Andrew Dr Unit 124",
            "address_purpose": "LOCATION",
            "city": "Vidalia",
            "state": "GA",
            "postal_code": "304747241",
            "country_code": "US",
            "telephone_number": "912-352-8346",
            "fax_number": "912-355-5515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILDES",
        "first_name": "DEANNA",
        "middle_name": "M",
        "credential": "RN, BSN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-22",
        "last_updated": "2022-09-13",
        "certification_date": "2022-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN077963",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003115053F",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003115053A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003115053C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEANNA",
            "last_name": "MAYBERRY",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nakiah Janae Wilcox, FNP
• Amethyst Wilder, MD
• Ashley C Wilder
• Jessica Marie Wilder, M.D.
• Samuel Garrett Wilder, MD
• Tyler John Wildes, MD, PHD
• Wildlight Counseling Services, LLC
• Gregory A Wilets, MD
• Georganna Wiley, CNM, MSN, WHNP
• Jordan Wiley

• Nurse Practitioner in Savannah, GA
• Providers in Savannah, GA by specialty
• Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.