NPIMap

Individual provider Active NPI

Nicholas Charles Wild, MD

  • Family Medicine Physician
  • Manchester Center, VT
National Provider Identifier
1144714726
Registry record updated Jul 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
042.0015274 Issued in VT
Practice address
5957 VT-7a
Manchester Center, VT 05255
Phone
(802) 362-4440
NPI assigned
Jun 18, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X MT215504 PA
Family Medicine Physician 207Q00000X 042.0015274 VT Primary

Addresses

Primary practice location

5957 VT-7a
Manchester Center, VT 05255

Mailing address

5957 VT-7a
Manchester Center, VT 05255
Phone (802) 362-4440

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT
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
I20210928001031 VT Practitioner - Family Practice 9032468673 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Albany Medical College of Union University, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southwestern Vermont Medical Center, IncGroup PAC ID 0143138446, 174 clinicians

Practice addresses (Care Compare)

5957 Main St
Manchester Center, VT 05255-8913
Phone (802) 362-4440

Hospital & facility affiliations

  • Vna & Hospice of the Southwest Region, Inc. Home health agency, Rutland, VT, CCN 477007
  • Bayada Home Health Care, Inc. Home health agency, Rutland, VT, CCN 477019
  • Vna & Hospice of Southwest Region, Inc. Hospice, Rutland, VT, CCN 471507
  • Southwestern Vermont Medical Center Hospital, Bennington, VT, CCN 470012
  • Rutland Regional Medical Center Hospital, Rutland, VT, CCN 470005
  • Grace Cottage Hospital Hospital, Townshend, VT, CCN 471300
  • Mary Hitchcock Memorial Hospital Hospital, Lebanon, NH, CCN 300003

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
042.0015274VTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southwestern Vermont Medical Center Inc. Family Medicine CurrentSince Aug 1, 2021 Accepting new patients
Southwestern Vermont Medical Center Inc. CurrentSince Aug 1, 2021 Accepting new patients
Southwestern Vermont Medical Center, Inc Past Accepting new patients

Locations

100 Hospital Dr
#44
Bennington, VT 05201
Phone (802) 442-4509

140 Hospital Dr
Ste 116
Bennington, VT 05201
Phone (802) 447-1836

5957 Main St
Manchestr Ctr, VT 05255
Phone (802) 362-4440

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.

Hospital & facility affiliations 12

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": "1529280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626825600000",
    "number": "1144714726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5957 VT-7A",
            "city": "MANCHESTER CENTER",
            "state": "VT",
            "postal_code": "05255",
            "telephone_number": "802-362-4440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5957 VT-7A",
            "city": "MANCHESTER CENTER",
            "state": "VT",
            "postal_code": "05255",
            "telephone_number": "802-362-4440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILD",
        "first_name": "NICHOLAS",
        "middle_name": "CHARLES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-18",
        "last_updated": "2021-07-21",
        "certification_date": "2021-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": "MT215504",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VT",
            "license": "042.0015274",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester Center, VT

Sources for this page

Verify at the official NPI Registry.