James Oscar Wilde Jr., M.D.
Individual provider Active NPI Family Medicine Physician · Charleston, MS
NPI 1003921172 · NPPES record last updated May 13, 2014
Key facts
- NPI
- 1003921172
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 22475 (MS)
- Practice address
- 201 S. Market St.
Charleston, MS 38921 - Phone
- (662) 625-7118
- Fax
- (662) 647-8954
- NPI assigned
- Aug 20, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Tallahatchie General Hospital
Practice addresses (Care Compare)
1301 Sunset Dr
Suite E
Grenada, MS 38901-4103
Phone (662) 625-7191
141 Dr T T Lewis Circle
Charleston, MS 38921-2236
Phone (662) 647-5392
Hospital & facility affiliations
- Tallahatchie General Hospital-Cah
- Tallahatchie General Hospital-Cah
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130606000237 | MS | Practitioner - Family Practice | 6608846886 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tallahatchie General Hospital | Current | Accepting new patients | |
| Tallahatchie General Hospital | Current |
Accepting new patients | |
| Tallahatchie General Hospital | Current |
Accepting new patients | |
| Midwest Hospitalists Services PLLC | Past | Accepting new patients | |
| Kickapoo Tribal Health Center | Past | Accepting new patients | |
| Hospital Care Consultants of Sallisaw | Past | Accepting new patients |
Locations
1301 Sunset Dr
Ste E
Grenada, MS 38901
Phone (662) 229-0069
Interoperability endpoints
- https://fhir-usa.unify.chbase.com/org/tallagh-438e232a
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 23852 | OK | |
| Family Medicine Physician | 207Q00000X | 22475 | MS | Yes |
Addresses
Primary practice location
201 S. Market St.
Charleston, MS 38921
Mailing address
201 S. Market St.
Charleston, MS 38921
Phone (662) 625-7118
Other providers in Charleston, MS
- Sammie M Tellis
- The Pharmacy of Charleston
- Cassala Ward
- Wiggins Family Dental, PLLC
- Kyle Wiggins
- Audrey Leann Williamson
- Wolfe Family Medical Clinic PLLC
- Woods Drug Store Inc
All providers in Charleston, MS · Family Medicine Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 13, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.