Individual provider Active NPI

Ashley A Wilda, PA-C

  • Physician Assistant
  • Wyoming, MI
National Provider Identifier
1043575855
Registry record updated Dec 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601006374 Issued in MI
Practice address
2215 44TH St SW
Wyoming, MI 49519-6439
Phone
(616) 252-8300
Fax
(616) 252-8460
NPI assigned
Jul 9, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601006374 MI Primary

Addresses

Primary practice location

2215 44TH St SW
Wyoming, MI 49519-6439

Mailing address

5900 Byron Center Ave SW
Medical Adminstration
Wyoming, MI 49519-9606
Phone (616) 252-3243

Other names 1

  • Ashley A Vycital Former name

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20120921000606 MI Practitioner - Physician Assistant 8224286919 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5601006374MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Metropolitan Hospital CurrentSince Jun 1, 2016 Accepting new patients
Metropolitan Hospital CurrentSince Jun 1, 2016 Accepting new patients
Metropolitan Hospital Past Accepting new patients

Locations

4200 Division Ave N
Comstock Park, MI 49321
Phone (616) 252-1600

5950 Metro Way SW
Wyoming, MI 49519
Phone (616) 252-8100

5900 Byron Center Ave SW
Wyoming, MI 49519
Phone (616) 252-3243

2215 44th St SW
Ste 100
Wyoming, MI 49519
Phone (616) 252-8300

2215 44th St SW
Wyoming, MI 49519
Phone (616) 252-8300

Interoperability endpoints

  • Direct secure messaging: awilda49021@direct.metrohealth.net

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1341792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512086400000",
    "number": "1043575855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5900 BYRON CENTER AVE SW",
            "address_2": "MEDICAL ADMINSTRATION",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495199606",
            "telephone_number": "616-252-3243",
            "fax_number": "616-252-0260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2215 44TH ST SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495196439",
            "telephone_number": "616-252-8300",
            "fax_number": "616-252-8460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDA",
        "first_name": "ASHLEY",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-09",
        "last_updated": "2017-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601006374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ASHLEY",
            "last_name": "VYCITAL",
            "middle_name": "A",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Wyoming, MI

Sources for this page

Verify at the official NPI Registry.