Wylder Shepherd Fondaw, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-10234 Issued in NC

Practice address

1126 N Church St
Greensboro, NC 27401-1000

Phone

(336) 832-7000

NPI assigned

Jun 3, 2020

Last updated

Jul 18, 2023By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in NC, AK2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Camai Community Health Center IncGroup PAC ID 3476690876, 12 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Norton Sound Health Corporation

  • Critical Access Hospital
  • Nome, AK
  • NPI 1154358232

  Physician Assistant

  Medicare reassignment NPD
• Wake Forest Emergency Providers

  • Multi-Specialty Clinic/Center
  • Statesville, NC
  • NPI 1396216735
  Medicare reassignment
• Camai Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Naknek, AK
  • NPI 1679718019
  Care Compare group
• Norton Sound Health Corporation

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Nome, AK
  • NPI 1427187046
  NPD

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

{
    "created_epoch": "1591142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689638400000",
    "number": "1205450400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 SEWARD DR",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376047143",
            "telephone_number": "828-231-3564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1126 N CHURCH ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274011000",
            "telephone_number": "336-832-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONDAW",
        "first_name": "WYLDER",
        "middle_name": "SHEPHERD",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-03",
        "last_updated": "2023-07-18",
        "certification_date": "2023-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-10234",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cristen Michelle Fogle, COTA/L
• Holly Fogleman, CMA
• Kelly A Fogleman, MD
• Candace Folden, LPC
• Roger Allen Foley, CRNA
• Elizabeth Fondow, PA-C
• Benjamin Daniel Fonke, D.C.
• Daniel J. Fonke, D.C.
• Jonathan Vincent Fonke, D.C.
• Timothy P Fontaine, MD

• Physician Assistant in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2023; 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.