Active NPI
Jeffrey M Wolk, MD
- Urology Physician
- Sierra Vista, AZ
National Provider Identifier
1184649634
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- 33318
- Practice address
- 3410 Canyon de Flores
Suite B
Sierra Vista, AZ 85650-5372 - Phone
- (520) 459-4477
- Fax
- (520) 803-9572
- NPI assigned
- Jul 13, 2006
- Last updated
- Feb 13, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | 33318 | AZ | Primary |
Addresses
Primary practice location
3410 Canyon de Flores
Suite B
Sierra Vista, AZ 85650-5372
Mailing address
3410 Canyon de Flores
Suite B
Sierra Vista, AZ 85650-5372
Phone (520) 459-4477
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 890790 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found.
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cochise Oncology LLC | Past | Accepting new patients | |
| Conant Urology, LLC | Urology | Past | Accepting new patients |
| Southwest Anesthesiology Business Associates PC | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Radiation Oncology Physician
- Sierra Vista, AZ
- NPI 1013954858
-
- Anesthesiology Physician
- Sierra Vista, AZ
- NPI 1467725499
-
- Urology Physician
- Waterbury, DC
- NPI 1225250681
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1297555200000",
"number": "1184649634",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3410 CANYON DE FLORES",
"address_2": "SUITE B",
"city": "SIERRA VISTA",
"state": "AZ",
"postal_code": "856505372",
"telephone_number": "520-459-4477",
"fax_number": "520-803-9572"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3410 CANYON DE FLORES",
"address_2": "SUITE B",
"city": "SIERRA VISTA",
"state": "AZ",
"postal_code": "856505372",
"telephone_number": "520-459-4477",
"fax_number": "520-803-9572"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLK",
"first_name": "JEFFREY",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-13",
"last_updated": "2011-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "AZ",
"license": "33318",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "890790",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sierra Vista, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.