Individual provider Active NPI

Rory Patrick Wildner, PA-C

  • Physician Assistant
  • Kalamazoo, MI
National Provider Identifier
1366960197
Registry record updated Jan 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601008330 Issued in MI
Practice address
5973 Beatrice Dr
Kalamazoo, MI 49009-9583
Phone
(269) 286-7110
NPI assigned
Aug 31, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601008330 MI Primary

Addresses

Primary practice location

5973 Beatrice Dr
Kalamazoo, MI 49009-9583

Mailing address

601 John St # 42
Kalamazoo, MI 49007-5341

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.bronsonhg.org Direct Bronson Healthcare Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170921000997 MI Practitioner - Physician Assistant 6608140140 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bronson Methodist HospitalGroup PAC ID 0244148633, 721 clinicians

Practice addresses (Care Compare)

601 John St
Kalamazoo, MI 49007-5377

6210 W Main St
Kalamazoo, MI 49009-8925
Phone (269) 286-7030

6220 W Main St
Aec Clinic
Kalamazoo, MI 49009-8925
Phone (269) 276-4744

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Bronson Methodist Hospital Physician Assistant CurrentSince Jan 8, 2023 Accepting new patients
Hometown Urgent Care of Michigan, P.C. CurrentSince Sep 14, 2021 Accepting new patients
Hometown Urgent Care of Michigan, P.C. Current Accepting new patients
Hometown Urgent Care of Michigan, PC CurrentSince Sep 14, 2021 Accepting new patients
Dayone City Care Medical PastSince Jul 1, 2022 Accepting new patients

Locations

363 Fremont St
Ste 203
Battle Creek, MI 49017
Phone (269) 969-6123

300 North Ave
Fl 2
Battle Creek, MI 49017
Phone (269) 245-5862

601 John St
#42
Kalamazoo, MI 49007
Phone (269) 341-7806

601 John St
Ste M-124
Kalamazoo, MI 49007
Phone (269) 341-7500

1634 Gull Rd
Kalamazoo, MI 49048
Phone (269) 903-2835

5973 Beatrice Dr
Kalamazoo, MI 49009
Phone (269) 286-7110

601 John St
Kalamazoo, MI 49007
Phone (269) 341-7100

Interoperability endpoints

  • FHIR API: https://app.meldrx.com/api/fhir/ei-dayone
  • Direct secure messaging: direct@direct.bronsonhg.org

Organizations & group practices 5

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 3

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": "1504137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673395200000",
    "number": "1366960197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 JOHN ST # 42",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490075341",
            "fax_number": "269-969-6122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5973 BEATRICE DR",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490099583",
            "telephone_number": "269-286-7110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDNER",
        "first_name": "RORY",
        "middle_name": "PATRICK",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-31",
        "last_updated": "2023-01-11",
        "certification_date": "2023-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601008330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.bronsonhg.org",
            "affiliation": "Y",
            "endpointDescription": "Bronson Healthcare Group Direct address",
            "affiliationName": "Bronson Healthcare Group",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Continuity of Care Document",
            "address_1": "601 John St",
            "city": "Kalamazoo",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490075341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.