NPIMap

Individual provider Active NPI

Corin Q Wilde, DPM

  • Foot & Ankle Surgery Podiatrist
  • Pittsburg, KS
National Provider Identifier
1285616375
Registry record updated Oct 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
12-00315 Issued in KS
Practice address
407 E Centennial Dr
Pittsburg, KS 66762-6505
Phone
(620) 231-5940
Fax
(620) 231-5948
NPI assigned
Nov 15, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X 12-00315 KS Primary
Foot & Ankle Surgery Podiatrist 213ES0103X 2000168834 MO

Addresses

Primary practice location

407 E Centennial Dr
Pittsburg, KS 66762-6505

Mailing address

407 E Centennial Dr
Pittsburg, KS 66762-6505
Phone (620) 231-5940

Other identifiers 2

IdentifierTypeStateIssuer
UMWAOtherKS0638544
114056OtherKSBLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
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
I20100505000571 KS Practitioner - Podiatry 0042286791 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Midwestern University, Chicago College of Osteopathic Med, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

407 E Centennial Dr
Pittsburg, KS 66762-6505
Phone (620) 231-5940

Hospital & facility affiliations

  • Mercy Hospital Pittsburg, Inc Hospital, Pittsburg, KS, CCN 170006
  • Labette Health Hospital, Parsons, KS, CCN 170120
  • Girard Medical Center Hospital, Girard, KS, CCN 171376
  • Mercy Hospital Carthage Hospital, Carthage, MO, CCN 261338

Merit-based Incentive Payment System (MIPS)

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

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue86
Removal of skin lesions186
Removal of nail tissue2799
Removal or shaving of skin growth169

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12-00315KSMDFoot & Ankle Surgery Podiatrist
2000168834MOMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Wilde Foot & Ankle Clinic PA Foot & Ankle Surgery CurrentSince Jul 3, 2000 Accepting new patients
Renu Medical & Spa, LLC Past Accepting new patients

Locations

909 E Centennial Dr
Ste 6
Pittsburg, KS 66762
Phone (620) 231-5940

407 E Centennial Dr
Pittsburg, KS 66762
Phone (620) 231-5940

Organizations & group practices 2

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 5

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": "1132012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413936000000",
    "number": "1285616375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 E CENTENNIAL DR",
            "city": "PITTSBURG",
            "state": "KS",
            "postal_code": "667626505",
            "telephone_number": "620-231-5940",
            "fax_number": "620-231-5948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 E CENTENNIAL DR",
            "city": "PITTSBURG",
            "state": "KS",
            "postal_code": "667626505",
            "telephone_number": "620-231-5940",
            "fax_number": "620-231-5948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDE",
        "first_name": "CORIN",
        "middle_name": "Q",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-15",
        "last_updated": "2014-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "KS",
            "license": "12-00315",
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "MO",
            "license": "2000168834",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "0638544",
            "identifier": "UMWA",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "114056",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pittsburg, KS

Sources for this page

Verify at the official NPI Registry.