NPIMap

Individual provider Active NPI

Philip David Wiley, MD

  • Otolaryngology Physician
  • Durango, CO
National Provider Identifier
1467419135
Registry record updated Aug 30, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
35193 Issued in CO
Practice address
1165 S Camino del Rio
Ste 200
Durango, CO 81303-6824
Phone
(970) 247-2920
Fax
(970) 247-2923
NPI assigned
Apr 27, 2006
Last updated
Aug 30, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 35193 CO Primary

Addresses

Primary practice location

1165 S Camino del Rio
Ste 200
Durango, CO 81303-6824

Mailing address

1165 S Camino del Rio
Ste 200
Durango, CO 81303-6824
Phone (970) 247-2920

Other identifiers 2

IdentifierTypeStateIssuer
01351931MedicaidCO
Q5374MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20120509000711 CO Practitioner - Otolaryngology 2860467156 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
University of Michigan Medical School, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Philip D Wiley MD PCGroup PAC ID 0840284758, 2 clinicians

Practice addresses (Care Compare)

1165 S Camino del Rio
Suite 200
Durango, CO 81303-6824
Phone (970) 247-2920

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35193COMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Philip D Wiley MD PC Otolaryngology CurrentSince Jun 10, 1996 Accepting new patients
Montezuma Hearing Clinic, Inc. CurrentSince Jul 1, 2004 Accepting new patients

Locations

1165 S Camino del Rio
Ste 200
Durango, CO 81303
Phone (970) 247-2920

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, 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": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1188432000000",
    "number": "1467419135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1165 S CAMINO DEL RIO",
            "address_2": "STE 200",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813036824",
            "telephone_number": "970-247-2920",
            "fax_number": "970-247-2923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1165 S CAMINO DEL RIO",
            "address_2": "STE 200",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813036824",
            "telephone_number": "970-247-2920",
            "fax_number": "970-247-2923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILEY",
        "first_name": "PHILIP",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-27",
        "last_updated": "2007-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "CO",
            "license": "35193",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01351931",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q5374",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Durango, CO

Sources for this page

Verify at the official NPI Registry.