Individual provider Active NPI

Lori Ann Kocur-Wilde, DPM

  • Podiatrist
  • King of Prussia, PA
National Provider Identifier
1326088071
Registry record updated Jun 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
SC 003384L Issued in PA
Practice address
134 Rebel Rd
King of Prussia, PA 19406-2383
Phone
(215) 696-6078
NPI assigned
Jun 8, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 9, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X SC 003384L PA Primary

Addresses

Primary practice location

134 Rebel Rd
King of Prussia, PA 19406-2383

Mailing address

134 Rebel Rd
King of Prussia, PA 19406-2383
Phone (215) 696-6078

Other identifiers 3

IdentifierTypeStateIssuer
0431485000OtherPAINDEPENDENCE BLUE CROSS
0431485000OtherPAAMERI HEALTH PERS CH
608729OtherPAHIGHMARK BLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040405000182 PA Practitioner - Podiatry 3678566965 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Temple University School of Podiatric Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

134 Rebel Rd
King of Prussia, PA 19406-2383
Phone (215) 696-6078

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of nail tissue1106
Removal or shaving of skin growth144

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SC 003384LPAMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
La Kocur Wilde PC Podiatrist CurrentSince Sep 21, 2010 Accepting new patients
Dr. Cheryl Haag Podiatrist Past Accepting new patients
Deborah J. Sharlin Podiatrist Past Accepting new patients
Highpoint Foot and Ankle Center LLC Podiatrist PastSince Jan 22, 2013 Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402272000000",
    "number": "1326088071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 REBEL RD",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194062383",
            "telephone_number": "215-696-6078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 REBEL RD",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194062383",
            "telephone_number": "215-696-6078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOCUR-WILDE",
        "first_name": "LORI",
        "middle_name": "ANN",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-08",
        "last_updated": "2014-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "PA",
            "license": "SC 003384L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENCE BLUE CROSS",
            "identifier": "0431485000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERI  HEALTH  PERS CH",
            "identifier": "0431485000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE CROSS BLUE SHIELD",
            "identifier": "608729",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in King of Prussia, PA

Sources for this page

Verify at the official NPI Registry.