NPIMap

Individual provider Active NPI

Wiley Smart McCreedy, PA

  • Physician Assistant
  • Durango, CO
National Provider Identifier
1134601180
Registry record updated Feb 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0006628 Issued in CO
Practice address
1 Mercado St Ste 202
Durango, CO 81301-7307
Phone
(970) 764-9400
Fax
(970) 764-9449
NPI assigned
Sep 5, 2018
Last updated
Feb 12, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Physician Assistant 363A00000X PA.0006628 CO Primary

Addresses

Primary practice location

1 Mercado St Ste 202
Durango, CO 81301-7307

Mailing address

2112 NW Quimby St Apt 542
Portland, OR 97210-2380
Phone (970) 729-0488

Other practice location 1

19250 SW 65th Ave Ste 260
Tualatin, OR 97062-7747
Phone (150) 388-5884

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210218001214 CO Practitioner - Physician Assistant 9537404892 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Catholic Health Initiatives ColoradoGroup PAC ID 8022927342, 1,230 clinicians

Practice addresses (Care Compare)

1 Mercado St
Suite 202
Durango, CO 81301-7307
Phone (970) 764-9400

1010 Three Springs Blvd
Durango, CO 81301-8296

41 State Hwy 67
Woodland Park, CO 80863-5008
Phone (719) 776-4780

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.06 of 100Reported as group
Quality
89.53
Promoting interoperability
100
Improvement activities
40
Cost
74

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Catholic Health Initiatives Colorado CurrentSince Feb 1, 2021 Accepting new patients
Catholic Health Initiatives Colorado CurrentSince Feb 1, 2021 Accepting new patients
Catholic Health Initiatives Colorado Past Accepting new patients

Locations

1 Mercado St
Ste 160
Durango, CO 81301
Phone (970) 385-9850

1 Mercado St
Ste 202
Durango, CO 81301
Phone (970) 247-5362

41 State Highway 67
Woodland Park, CO 80863
Phone (719) 686-0551

Organizations & group practices 4

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

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1536105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613088000000",
    "number": "1134601180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2112 NW QUIMBY ST APT 542",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102380",
            "telephone_number": "970-729-0488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MERCADO ST STE 202",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813017307",
            "telephone_number": "970-764-9400",
            "fax_number": "970-764-9449"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19250 SW 65th Ave Ste 260",
            "address_purpose": "LOCATION",
            "city": "Tualatin",
            "state": "OR",
            "postal_code": "970627747",
            "country_code": "US",
            "telephone_number": "150-388-5884",
            "fax_number": "503-885-8946",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCREEDY",
        "first_name": "WILEY",
        "middle_name": "SMART",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-05",
        "last_updated": "2021-02-12",
        "certification_date": "2021-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0006628",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Durango, CO

Sources for this page

Verify at the official NPI Registry.