Dafna Rachel Wild, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

25MP00209700 Issued in NJ

Practice address

100 Pavonia Ave
Suite 409
Jersey City, NJ 07310-2778

Phone

(201) 626-4040

NPI assigned

Jun 15, 2009

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

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

Specialty

Physician Assistant

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Clark Dermatology LLCGroup PAC ID 5395703573, 46 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/JHEAAA
• Direct secure messaging: dafna.wild@metroderm.eclinicaldirectplus.com
• Direct secure messaging: dafnawild@abelesdermatology.medentdirect.com

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.

• Clark Dermatology LLC

  • Dermatology Physician
  • Clark, NJ
  • NPI 1851562425
  Medicare reassignment Care Compare group
• Clark Dermatology, LLC

  • Dermatology Physician
  • Staten Island, NY
  • NPI 1417316274
  NPD (past)

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

{
    "created_epoch": "1245024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245024000000",
    "number": "1174750319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PAVONIA AVE",
            "address_2": "SUITE 409",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073102778",
            "telephone_number": "201-626-4040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PAVONIA AVE",
            "address_2": "SUITE 409",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073102778",
            "telephone_number": "201-626-4040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILD",
        "first_name": "DAFNA",
        "middle_name": "RACHEL",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-06-15",
        "last_updated": "2009-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00209700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ronda M Whitley, MD
• Elizabeth Wick, PTA
• Constance Wieczorek, LSW
• Celina Marie Wigle-Olias-Varga, LSW
• Samantha Hope Wilcox, PA-C
• Lietea Wilkins
• Jackqueline A Williams Clifton
• Antonio Williams, CADC
• Celeste Williams
• James Dashuan Williams, LCSW, LCADC, CCTP

• Physician Assistant in Jersey City, NJ
• Providers in Jersey City, NJ by specialty
• Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2009; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.