NPIMap

Individual provider Active NPI

Robert Wiley, MD

  • Family Medicine Physician
  • Glen Mills, PA
National Provider Identifier
1417419250
Registry record updated Sep 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD475558 Issued in PA
Practice address
1020 Baltimore Pike Ste 100
Glen Mills, PA 19342-1365
Phone
(484) 227-7790
Fax
(484) 227-7791
NPI assigned
Apr 1, 2019
Last updated
Sep 2, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Family Medicine Physician 207Q00000X MD475558 PA Primary

Addresses

Primary practice location

1020 Baltimore Pike Ste 100
Glen Mills, PA 19342-1365

Mailing address

1020 Baltimore Pike Ste 100
Glen Mills, PA 19342-1365
Phone (484) 227-7790

Other practice location 1

833 Chestnut St Ste 301
Philadelphia, PA 19107-4405
Phone (215) 955-7190

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20220914001086 PA Practitioner - Family Practice 8224363312 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Jefferson Medical College of Thomas Jefferson University, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Main Line HealthcareGroup PAC ID 1951215201, 1,154 clinicians

Practice addresses (Care Compare)

1020 Baltimore Pike
Suite 100
Glen Mills, PA 19342-1013
Phone (484) 227-7790

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Main Line Healthcare Family Medicine CurrentSince Sep 1, 2022 Accepting new patients

Locations

830 Old Lancaster Rd
Ste 108
Bryn Mawr, PA 19010
Phone (610) 520-5200

1020 Baltimore Pike
Ste 100
Glen Mills, PA 19342
Phone (484) 227-7790

3803 West Chester Pike
Ste 160
Newtown Square, PA 19073
Phone (484) 337-1530

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1554076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662076800000",
    "number": "1417419250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 BALTIMORE PIKE STE 100",
            "city": "GLEN MILLS",
            "state": "PA",
            "postal_code": "193421365",
            "telephone_number": "484-227-7790",
            "fax_number": "484-227-7791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 BALTIMORE PIKE STE 100",
            "city": "GLEN MILLS",
            "state": "PA",
            "postal_code": "193421365",
            "telephone_number": "484-227-7790",
            "fax_number": "484-227-7791"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "833 Chestnut St Ste 301",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191074405",
            "country_code": "US",
            "telephone_number": "215-955-7190",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILEY",
        "first_name": "ROBERT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-01",
        "last_updated": "2022-09-02",
        "certification_date": "2022-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD475558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Mills, PA

Sources for this page

Verify at the official NPI Registry.