John A Wilder, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

3005 Issued in NC

Practice address

14818 Capricorn LN
Charlotte, NC 28277-2927

Phone

(704) 517-2138

NPI assigned

Oct 4, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Jay Wilder Other name

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Inpatient Consultants of North Carolina, PC

  • Internal Medicine Physician
  • Charlotte, NC
  • NPI 1669422846

  Psychologist

  Medicare reassignment NPD
• Opportunities Industrialization Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Rocky Mount, NC
  • NPI 1396103305
  Medicare reassignment NPD
• NM Pacs 2 LLC

  • Hospitalist Physician
  • Albuquerque, NM
  • NPI 1366928749

  NC

  Medicare reassignment NPD
• Inpatient Consultants of North Carolina, PC

  • Hospitalist Physician
  • Raleigh, NC
  • NPI 1790173680
  NPD
• Opportunities Industrialization Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Rocky Mount, NC
  • NPI 1932923950
  NPD
• Paradigm Health Services, Inc

  • Mental Health Counselor
  • Clearwater, FL
  • NPI 1578519146
  NPD (past)

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582761600000",
    "number": "1164517819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13575 58TH ST N",
            "address_2": "SUITE 187",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337603740",
            "telephone_number": "800-632-6074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14818 CAPRICORN LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282772927",
            "telephone_number": "704-517-2138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDER",
        "first_name": "JOHN",
        "middle_name": "A",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2020-02-27",
        "certification_date": "2020-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "P3005",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "3005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE # - PARADIGM",
            "identifier": "P00316181",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6000785",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAY",
            "last_name": "WILDER",
            "credential": "PH.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Elise Kathryn Wild, M.S., CCC-SLP
• Matthew Wilde, MD
• Brian John Wilder, MD
• Claire Anne Evans Wilder, MD
• Hayden Wilder
• Thona Wilder, BEHAVIOR TECHNICIAN
• Wildflower Therapy Collective
• Wildflower Therapy PLLC
• Loran Marie Wile, PA-C
• Margaret-Anne Wiles, MA, LCMHCA

• Psychologist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.