Individual provider Active NPI

Wilder M Pinnock, DNP

  • Family Nurse Practitioner
  • Boston, MA
National Provider Identifier
1407936503
Registry record updated Oct 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN231670 Issued in MA
Practice address
801 Massachusetts Ave
Crosstown 6C
Boston, MA 02118-6110
Phone
(617) 414-5951
Fax
(617) 414-9201
NPI assigned
Oct 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN231670 MA Primary

Addresses

Primary practice location

801 Massachusetts Ave
Crosstown 6C
Boston, MA 02118-6110

Mailing address

960 Massachusetts Ave Ste 2
Boston, MA 02118-2690

Other identifiers 1

IdentifierTypeStateIssuer
110094810AMedicaidMA

Other names 1

  • Wilder M Pinnock-Tooley Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20051103000741 MA Practitioner - Nurse Practitioner 9234157827 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Evans Medical Foundation IncGroup PAC ID 7416946546, 525 clinicians

Practice addresses (Care Compare)

1 Boston Medical Ctr PL
Boston, MA 02118-2908
Phone (617) 638-8000

72 E Newton St
CR Evans 124
Boston, MA 02118-2308
Phone (617) 638-7253

88 E Newton St
Boston, MA 02118-2308
Phone (617) 414-5405

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Evans Medical Foundation, Inc. CurrentSince Jan 27, 2022 Accepting new patients
Boston Medical Center Corporation Current Accepting new patients

Locations

88 Newton St
Boston, MA 02118
Phone (617) 638-7350

960 Massachusetts Ave
Ste 2
Boston, MA 02118

801 Massachusetts Ave
#6C
Roxbury, MA 02118

Interoperability endpoints

  • Direct secure messaging: wpinnocktooley161494@direct.bmc.masshiway.net

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 8

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": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729814400000",
    "number": "1407936503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 MASSACHUSETTS AVE STE 2",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021182690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 MASSACHUSETTS AVE",
            "address_2": "CROSSTOWN 6C",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021186110",
            "telephone_number": "617-414-5951",
            "fax_number": "617-414-9201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PINNOCK",
        "first_name": "WILDER",
        "middle_name": "M",
        "credential": "DNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-16",
        "last_updated": "2024-10-25",
        "certification_date": "2024-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MA",
            "license": "RN231670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110094810A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "WILDER",
            "last_name": "PINNOCK-TOOLEY",
            "middle_name": "M",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.