John K Wildemore IV, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD423121 Issued in PA

Practice address

744 W Lancaster Ave
Suite 230
Wayne, PA 19087-2523

Phone

(610) 688-8750

Fax

(610) 688-8751

NPI assigned

Dec 28, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

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

Specialty

Dermatology

Education

Jefferson Medical College of Thomas Jefferson University, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

John K. Wildemore, MD, LLCGroup PAC ID 5698775104, 4 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

92.44 of 100Reported as group

Quality

100

Promoting interoperability

100

Improvement activities

40

Cost

74.8

Procedures performed for Medicare patients

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.

• John K. Wildemore, MD, LLC

  • Dermatology Physician
  • Wayne, PA
  • NPI 1376632257
  Medicare reassignment Care Compare group NPD Authorized official
• Pine Street Dermatology, PC

  • Dermatology Physician
  • Philadelphia, PA
  • NPI 1396822870
  NPD (past)
• Karen S Harkaway MD LLC

  • Dermatology Physician
  • Delran, NJ
  • NPI 1619073723
  NPD (past)
• Schweiger Dermatology, PC

  • Dermatology Physician
  • Elmer, NJ
  • NPI 1104229392
  NPD (past)

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

{
    "created_epoch": "1135728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1295712487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "744 W LANCASTER AVE",
            "address_2": "SUITE 230",
            "city": "WAYNE",
            "state": "PA",
            "postal_code": "190872523",
            "telephone_number": "610-688-8750",
            "fax_number": "610-688-8750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "744 W LANCASTER AVE",
            "address_2": "SUITE 230",
            "city": "WAYNE",
            "state": "PA",
            "postal_code": "190872523",
            "telephone_number": "610-688-8750",
            "fax_number": "610-688-8751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDEMORE",
        "first_name": "JOHN",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "PA",
            "license": "MD423121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tara Wheeler, PSY.D.
• Stephen Anthony Whitaker, OWNER
• Andrea White, L.AC.
• Tracy S Whitman, PT
• Stephanie Wiegert
• Rachel Wiley, O.T.
• William a Cleveland DMD & Associates
• Ronald Craig Williams, D.M.D.
• Sherrie L Wilson
• Sara Witkowski

• Dermatology Physician in Wayne, PA
• Providers in Wayne, PA by specialty
• Dermatology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.