Elaina Constance Wild, ELAINA WILD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

30995 Issued in NE

Practice address

21St MDG 559 Vincent Street Pafb
Colorado Springs, CO 80914-1540

Phone

(402) 294-2056

NPI assigned

May 11, 2010

Sex

Female

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 NE

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

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.

• Unmc Physicians

  • Multi-Specialty Clinic/Center
  • Omaha, NE
  • NPI 1417912114
  Medicare reassignment NPD

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

{
    "created_epoch": "1273536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654732800000",
    "number": "1245558527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21ST MDG 559 VINCENT STREET PAFB",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809141540",
            "telephone_number": "719-556-5898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21ST MDG 559 VINCENT STREET PAFB",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809141540",
            "telephone_number": "402-294-2056"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2501 Capehart Rd",
            "address_purpose": "LOCATION",
            "city": "Omaha",
            "state": "NE",
            "postal_code": "68113",
            "country_code": "US",
            "telephone_number": "402-294-2056",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILD",
        "first_name": "ELAINA",
        "middle_name": "CONSTANCE",
        "name_prefix": "Dr.",
        "credential": "ELAINA WILD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-11",
        "last_updated": "2022-06-09",
        "certification_date": "2022-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "30995",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01071051A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paula Wilcox
• Robert Todd Wilcox, M.D.
• William D Wilcox, MD
• Shana Wilcoxson
• Wild Bloom Wellness LLC
• Jason R. Wild, M.D.
• Kathryn Elizabeth Wilde, WHNP
• Bonita Jo Wilder, CAC III
• Kate M Wilder, LPCC
• Caitlin Wildey

• Family Medicine Physician in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Family Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.