Active NPI
Gary Dewayne Wiley Jr., PA-C
- Physician Assistant
- Marina del Rey, CA
National Provider Identifier
1427885656
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA65066
- Practice address
- 4011 Via Marina Apt 107
Marina del Rey, CA 90292-8201 - Phone
- (360) 441-4248
- NPI assigned
- Sep 19, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA65066 | CA | Primary |
Addresses
Primary practice location
4011 Via Marina Apt 107
Marina del Rey, CA 90292-8201
Mailing address
4011 Via Marina Apt 107
Marina del Rey, CA 90292-8201
Phone (360) 441-4248
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
19803 1St Ave S
Suite 200
Normandy Park, WA 98148-2410
Phone (480) 712-8319
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA65066 | CA | MD | Physician Assistant |
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1726704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727395200000",
"number": "1427885656",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4011 VIA MARINA APT 107",
"city": "MARINA DEL REY",
"state": "CA",
"postal_code": "902928201",
"telephone_number": "360-441-4248"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4011 VIA MARINA APT 107",
"city": "MARINA DEL REY",
"state": "CA",
"postal_code": "902928201",
"telephone_number": "360-441-4248"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILEY",
"first_name": "GARY",
"middle_name": "DEWAYNE",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-09-19",
"last_updated": "2024-09-27",
"certification_date": "2024-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA65066",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marina del Rey, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2024; 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.