Mary Jane Wildman, CRNP

Key facts

NPI

1174846166

Entity type

Individual (NPI type 1)

Primary specialty

Psychiatric/Mental Health Nurse Practitioner 363LP0808X

License

SP028136 (PA)

Practice address

100 New Salem Rd
Suite 116
Uniontown, PA 15401-8936

Phone

(724) 437-0728

NPI assigned

Mar 5, 2010

Sex

Female

Sole proprietor

No

Organizations & group practices 1

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.

• Chestnut Ridge Counseling Services Inc Mental Health Clinic/Center (Including Community Mental Health Center) · Uniontown, PA · NPI 1063489482
  Medicare reassignment Care Compare group NPD PA · REGISTERED NURSE

Medicare Care Compare profile

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Chestnut Ridge Counseling Services Inc (29 clinicians)

Practice addresses (Care Compare)

Medicare participation

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mailbox@crcsi.credible2.direct-ci.com

Specialties & licenses

Addresses

Electronic endpoints

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 31, 2023.

{
    "created_epoch": "1267747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693440000000",
    "number": "1174846166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 NEW SALEM RD",
            "address_2": "SUITE 116",
            "city": "UNIONTOWN",
            "state": "PA",
            "postal_code": "154018936",
            "telephone_number": "724-437-0728",
            "fax_number": "724-437-0854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NEW SALEM RD",
            "address_2": "SUITE 116",
            "city": "UNIONTOWN",
            "state": "PA",
            "postal_code": "154018936",
            "telephone_number": "724-437-0728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDMAN",
        "first_name": "MARY",
        "middle_name": "JANE",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-05",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "PA",
            "license": "RN588934",
            "primary": false
        },
        {
            "code": "163WP0807X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Child & Adolescent",
            "state": "PA",
            "license": "RN588934",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "PA",
            "license": "SP028136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "maryjane.wildman@crcsi.org",
            "affiliation": "N",
            "endpointDescription": "work email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "100 New Salem Rd",
            "address_2": "SUITE 116",
            "city": "Uniontown",
            "state": "PA",
            "country_code": "US",
            "postal_code": "154018936",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mailbox@CRCSI.credible2.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "CHESTNUT RIDGE COUNSELING SERVICES INC",
            "address_1": "100 New Salem Rd",
            "address_2": "SUITE 116",
            "city": "Uniontown",
            "state": "PA",
            "country_code": "US",
            "postal_code": "154018936",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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All providers in Uniontown, PA · Psychiatric/Mental Health Nurse Practitioner in Pennsylvania