NPIMap

Organization Active NPI

Wildwood Emergency Group, LLC

  • Emergency Medicine Physician
  • Blacksburg, VA
National Provider Identifier
1013409721
Registry record updated Oct 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
WILDWOOD EMERGENCY GROUP, LLC
Practice address
3700 S Main St
Blacksburg, VA 24060-7017
Phone
(540) 951-1111
NPI assigned
May 30, 2018
Last updated
Oct 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2024

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

Authorized official

Name
Lisha C Falk
Title
VP of Contracting
Phone
(337) 609-1221

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU Primary
Physician Assistant 363A00000X NU
Nurse Practitioner 363L00000X NU

Addresses

Primary practice location

3700 S Main St
Blacksburg, VA 24060-7017

Mailing address

200 Corporate Blvd
Lafayette, LA 70508-3870
Phone (800) 893-9698

Other practice location 1

1145 W Main St
Christiansburg, VA 24073-4221
Phone (540) 251-8900

Other identifiers 1

IdentifierTypeStateIssuer
1013409721MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180730001151 VA Part B Supplier - Clinic/Group Practice 4789932385 Receives reassigned benefits from 99 practitioners
Practice locations: Blacksburg, VA; Christiansburg, VA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 100

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 100

NPI Registry JSON

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

{
    "created_epoch": "1527638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728000000000",
    "number": "1013409721",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CORPORATE BLVD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083870",
            "telephone_number": "800-893-9698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 S MAIN ST",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240607017",
            "telephone_number": "540-951-1111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1145 W Main St",
            "address_purpose": "LOCATION",
            "city": "Christiansburg",
            "state": "VA",
            "postal_code": "240734221",
            "country_code": "US",
            "telephone_number": "540-251-8900",
            "fax_number": "540-251-8901",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WILDWOOD EMERGENCY GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-30",
        "last_updated": "2024-10-04",
        "certification_date": "2024-10-04",
        "status": "A",
        "authorized_official_last_name": "FALK",
        "authorized_official_first_name": "LISHA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "VP OF CONTRACTING",
        "authorized_official_telephone_number": "337-609-1221"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013409721",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blacksburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.