Individual provider Active NPI

James B Wilde, M.D.

  • Anesthesiology Physician
  • Albuquerque, NM
National Provider Identifier
1275892739
Registry record updated Sep 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MD2016-0475 Issued in NM
Practice address
1720 Louisiana Blvd NE Ste 401
Albuquerque, NM 87110-7020
Phone
(505) 260-4300
Fax
(505) 260-4371
NPI assigned
May 3, 2012
Last updated
Sep 7, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MD2016-0475 NM Primary

Addresses

Primary practice location

1720 Louisiana Blvd NE Ste 401
Albuquerque, NM 87110-7020

Mailing address

1720 Louisiana Blvd NE Ste 401
Albuquerque, NM 87110-7020
Phone (505) 260-4300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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

Enrollment IDStateProvider typePAC IDDetails
I20201217002677 UT Practitioner - Anesthesiology 6709169220 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Pittsburgh School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Millcreek Anesthesia PCGroup PAC ID 0840194643, 45 clinicians

Practice addresses (Care Compare)

1200 E 3900
St Marks Hospital
Salt Lake City, UT 84124-1300
Phone (801) 268-7111

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD2016-0475NMMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Millcreek Anesthesia PC Anesthesiology CurrentSince Jan 4, 2021 Accepting new patients

Locations

1200 E 3900 S
Slc, UT 84124
Phone (801) 268-7111

Organizations & group practices 1

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.

Hospital & facility affiliations 2

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": "1336003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473206400000",
    "number": "1275892739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 LOUISIANA BLVD NE STE 401",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871107020",
            "telephone_number": "505-260-4300",
            "fax_number": "505-260-4371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 LOUISIANA BLVD NE STE 401",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871107020",
            "telephone_number": "505-260-4300",
            "fax_number": "505-260-4371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDE",
        "first_name": "JAMES",
        "middle_name": "B",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-03",
        "last_updated": "2016-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NM",
            "license": "MD2016-0475",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

Verify at the official NPI Registry.