NPIMap

Individual provider Active NPI

Jeanie M Wildes, NP

  • Primary Care Nurse Practitioner
  • Sedona, AZ
National Provider Identifier
1245390376
Registry record updated Apr 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
AP1131 Issued in AZ
Practice address
6446 State Route 179 Ste 209
Sedona, AZ 86351-7991
Phone
(928) 204-4900
Fax
(928) 204-4905
NPI assigned
Dec 11, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AZAP1131 AZ
Primary Care Nurse Practitioner 363LP2300X AP1131 AZ Primary

Addresses

Primary practice location

6446 State Route 179 Ste 209
Sedona, AZ 86351-7991

Mailing address

6446 State Route 179 Ste 209
Sedona, AZ 86351-7991
Phone (928) 204-4900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050314000347 AZ Practitioner - Nurse Practitioner 1850346818 Reassigns benefits to 1 organization
Practice locations: Sedona, AZ

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Phoenician Medical Center IncGroup PAC ID 0547169708, 36 clinicians

Practice addresses (Care Compare)

1343 N Alma School Rd
Suite 205
Chandler, AZ 85224-5903
Phone (480) 963-1853

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
21.22 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
70.74

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AZAP1131AZMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Phoenician Medical Center, Inc Internal Medicine CurrentSince Oct 1, 2025 Accepting new patients
Verde Community Healthcare LLC Past Accepting new patients
Dr. Thomas C Scherich Past Accepting new patients
Arizona Oncology Associates PC Internal Medicine PastSince Aug 1, 2004 Accepting new patients
Arizona Oncology Services Inc Past Accepting new patients

Locations

1343 N Alma School Rd
Ste 205
Chandler, AZ 85224
Phone (480) 722-2588

1343 N Alma School Rd
Ste 160
Chandler, AZ 85224
Phone (480) 444-7447

95 Soldiers Pass Rd
Ste B1
Sedona, AZ 86336
Phone (928) 204-4900

6446 State Route 179
Ste 209
Sedona, AZ 86351
Phone (928) 204-4900

Interoperability endpoints

  • Direct secure messaging: jeaniewildes.355.309@securemailmdscloud.mdsynergy.com

Organizations & group practices 5

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.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714003200000",
    "number": "1245390376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6446 STATE ROUTE 179 STE 209",
            "city": "SEDONA",
            "state": "AZ",
            "postal_code": "863517991",
            "telephone_number": "928-204-4900",
            "fax_number": "928-204-4905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6446 STATE ROUTE 179 STE 209",
            "city": "SEDONA",
            "state": "AZ",
            "postal_code": "863517991",
            "telephone_number": "928-204-4900",
            "fax_number": "928-204-4905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDES",
        "first_name": "JEANIE",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-11",
        "last_updated": "2024-04-25",
        "certification_date": "2024-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AZAP1131",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "AZ",
            "license": "AP1131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sedona, AZ

Sources for this page

Verify at the official NPI Registry.