Jenna Kaye Wildman, M.D.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

81716 Issued in SC

Practice address

2095 Henry Tecklenburg Dr
Charleston, SC 29414-5733

Phone

(843) 789-1892

Fax

(843) 606-8036

NPI assigned

Apr 8, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Obstetrics/Gynecology

Education

JC Edwards School of Medicine, Marshall University, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Obhg South Carolina PCGroup PAC ID 7012182504, 26 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Obhg South Carolina PC

  • Obstetrics & Gynecology Physician
  • Greenville, SC
  • NPI 1538457361
  Medicare reassignment Care Compare group NPD
• Fetter Health Care Network, Inc.

  • Federally Qualified Health Center (FQHC)
  • Charleston, SC
  • NPI 1003827304
  Medicare reassignment NPD
• Fetter Health Care Network, Inc.

  • Federally Qualified Health Center (FQHC)
  • Summerville, SC
  • NPI 1457007841
  Medicare reassignment NPD
• Fetter Health Care Network, Inc.

  • Federally Qualified Health Center (FQHC)
  • Summerville, SC
  • NPI 1518454818
  Medicare reassignment NPD
• Fetter Health Care Network, Inc.

  • Federally Qualified Health Center (FQHC)
  • Moncks Corner, SC
  • NPI 1659872059
  Medicare reassignment NPD
• Fetter Health Care Network, Inc.

  • Federally Qualified Health Center (FQHC)
  • Charleston, SC
  • NPI 1982124301
  Medicare reassignment NPD
• Roper Saint Francis Physicians Network

  • Surgery Physician
  • Charleston, SC
  • NPI 1124431606
  Medicare reassignment NPD
• Uwh of the Carolinas, PLLC

  • Obstetrics & Gynecology Physician
  • Morrisville, NC
  • NPI 1639506470

  SC

  Medicare reassignment NPD
• Fetter Health Care Network, Inc

  • Federally Qualified Health Center (FQHC)
  • Summerville, SC
  • NPI 1174378707
  NPD
• Roper Saint Francis Physicians Network

  • Obstetrics & Gynecology Physician
  • Charleston, SC
  • NPI 1811857352
  NPD
• Roper Saint Francis Physicians Network

  • Endocrinology, Diabetes & Metabolism Physician
  • Charleston, SC
  • NPI 1922665413
  NPD

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

{
    "created_epoch": "1396915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594598400000",
    "number": "1174942064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751649",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751649",
            "telephone_number": "251-415-8602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2095 HENRY TECKLENBURG DR",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294145733",
            "telephone_number": "843-789-1892",
            "fax_number": "843-606-8036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDMAN",
        "first_name": "JENNA",
        "middle_name": "KAYE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-08",
        "last_updated": "2020-07-13",
        "certification_date": "2020-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "SC",
            "license": "81716",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "817166",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Chamberlayne Wilde Jr., MD
• Fredreana Wilder
• Lashana Jonette Wilder, P.A.
• Lauren Elizabeth Wilder, MD
• Rachel Ann Wildman Dellos, DNP APRN-CNP NNP-BC
• Robert Boyd Wildman
• Chloe Wilds, LPC-A
• Robert H Wilds, OD
• Suzanne Lynn Wilds, D.C.
• Wildstein Spine Center, PA

• Obstetrics & Gynecology Physician in Charleston, SC
• Providers in Charleston, SC by specialty
• Obstetrics & Gynecology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 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.
• 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.