Pamela Marie Dewilde, DO (AS OF 6/17/18)

Primary specialty

Neuromusculoskeletal Medicine & OMM PhysicianTaxonomy code 204D00000X

License

3647 Issued in WV

Practice address

1464 Jefferson St N
Lewisburg, WV 24901-1380

Phone

(304) 645-3220

Fax

(844) 479-4545

NPI assigned

May 10, 2018

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 names 1

• Pamela Marie Kelso Former name

Medicare fee-for-service enrollment

Enrolled in WV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Osteopathic Manipulative Medicine

Education

Rowan University School of Osteopathic Medicine, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

West Virginia School of Osteopathic Medicine Clinic IncGroup PAC ID 0941113427, shared by 2 NPIs, 33 clinicians

Ballout International PLLCGroup PAC ID 5890045256, 48 clinicians

Evolutionary Healthcare West Virginia PLLCGroup PAC ID 6002390747, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Camc Greenbrier Valley Medical Center, Inc Hospital, Ronceverte, WV, CCN 510002

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: pamela.de.wilde.1@17660.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/17660/brand/1/csg/1/fhir/r4

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.

• Ballout International PLLC

  • Internal Medicine Physician
  • Vero Beach, FL
  • NPI 1629554225

  Neuromusculoskeletal Medicine & Omm, WV

  Medicare reassignment Care Compare group NPD
• Evolutionary Healthcare West Virginia PLLC

  • Neuromusculoskeletal Medicine & OMM Physician
  • Hurricane, WV
  • NPI 1053286815
  Medicare reassignment Care Compare group NPD (past)
• West Virginia School of Osteopathic Medicine Clinic Inc

  • Rural Health Clinic/Center
  • Lewisburg, WV
  • NPI 1013496991

  Neuromusculoskeletal Medicine & Omm

  Medicare reassignment NPD
• West Virginia School of Osteopathic Medicine Clinic Inc D/B/a Robert C. Byrd Clinic

  • Family Medicine Physician
  • Lewisburg, WV
  • NPI 1871539296
  Medicare reassignment NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Camc Greenbrier Valley Medical Center Inc

  • General Acute Care Hospital
  • Ronceverte, WV
  • NPI 1679299408
  Care Compare affiliation

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

{
    "created_epoch": "1525910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663632000000",
    "number": "1003305533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1464 JEFFERSON ST N",
            "city": "LEWISBURG",
            "state": "WV",
            "postal_code": "249011380",
            "telephone_number": "304-645-3220",
            "fax_number": "844-479-4545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1464 JEFFERSON ST N",
            "city": "LEWISBURG",
            "state": "WV",
            "postal_code": "249011380",
            "telephone_number": "304-645-3220",
            "fax_number": "844-479-4545"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1320 Maplewood Ave",
            "address_purpose": "LOCATION",
            "city": "Ronceverte",
            "state": "WV",
            "postal_code": "249708016",
            "country_code": "US",
            "telephone_number": "304-647-4411",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEWILDE",
        "first_name": "PAMELA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "DO (AS OF 6/17/18)",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-10",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "WV",
            "license": "3647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PAMELA",
            "last_name": "KELSO",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lisa Degraft
• James P. Dehaven, M.D.
• Brenda Deitz
• Joseph R. Desaulniers, PT
• Deen Ann Dever, SPEECH PATHOLOGIST
• Pamela Lynn Diehl
• Crissandra Digges
• Samuel Clay Dillon
• Pamela Frances Doering
• Teresa Dolin, LMT

• Neuromusculoskeletal Medicine & OMM Physician in Lewisburg, WV
• Providers in Lewisburg, WV by specialty
• Neuromusculoskeletal Medicine & OMM Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 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.