Individual provider Active NPI

Timothy W. Wild, MD

  • Otolaryngology Physician
  • Vacaville, CA
National Provider Identifier
1467530360
Registry record updated Dec 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
A61573 Issued in CA
Practice address
1 Quality Dr
Vacaville, CA 95688-9494
Phone
(707) 453-5000
NPI assigned
Nov 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2021

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 A61573 CA Primary

Addresses

Primary practice location

1 Quality Dr
Vacaville, CA 95688-9494

Mailing address

1800 Harrison St FL 7
Oakland, CA 94612-3466
Phone (510) 625-6262

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq Health Information Exchange (HIE) The Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101120000225 CA Practitioner - Otolaryngology 6204022940 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Boston University School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Adventist Health Physicians NetworkGroup PAC ID 3274580972, 628 clinicians

Practice addresses (Care Compare)

1524 W Lacey Blvd
Suite 101
Hanford, CA 93230-5990
Phone (559) 583-4695

Hospital & facility affiliations

  • Kaweah Health Medical Center Hospital, Visalia, CA, CCN 050057

Merit-based Incentive Payment System (MIPS)

Final score
95.77 of 100Reported as apm
Quality
81.54
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A61573CAMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health Physicians Network Current Accepting new patients
Adventist Health Physicians Network CurrentSince Mar 29, 2024 Accepting new patients
Adventist Health Physicians Network CurrentSince Mar 29, 2024 Accepting new patients
Jason Roos DO a Professional Medical Corporation CurrentSince Jan 6, 2024 Accepting new patients
Reedley Community Hospital CurrentSince Apr 1, 2024 Accepting new patients
Permanente Medical Group Inc Otolaryngology CurrentSince Oct 5, 2010 Accepting new patients
Reedley Community Hospital CurrentSince Apr 1, 2024 Accepting new patients
Permanente Medical Group Inc Otolaryngology Current Accepting new patients
Permanente Medical Group, Inc CurrentSince Oct 5, 2010 Accepting new patients
Hanford Community Hospital Past Accepting new patients
Reedley Community Hospital Past Accepting new patients
Adventist Health Heart Institute-Ukiah Past Accepting new patients
Adventist Health Tulare Past Accepting new patients

Locations

1680 E Herndon Ave
Ste 102
Fresno, CA 93720
Phone (559) 401-6058

1524 W Lacey Blvd
Ste 101
Hanford, CA 93230
Phone (559) 583-4695

1800 Harrison St
Fl 7
Oakland, CA 94612

1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015

372 W Cypress Ave
Reedley, CA 93654
Phone (559) 391-3110

901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500

3553 Camino Mira Costa
Ste A
San Clemente, CA 92672
Phone (949) 369-5932

2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000

710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400

7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000

951 E Merritt Ave
Tulare, CA 93274
Phone (559) 537-0348

1 Quality Dr
Vacaville, CA 95688
Phone (707) 453-5000

975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000

805 W Acequia Ave
Ste 1B
Visalia, CA 93291
Phone (559) 409-4720

1700 W Walnut Ave
#A
Visalia, CA 93277
Phone (559) 409-4720

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/a36dfa71-4dd3-4608-9cfb-c7a63ade5531/

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 1

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": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639353600000",
    "number": "1467530360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 HARRISON ST FL 7",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946123466",
            "telephone_number": "510-625-6262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 QUALITY DR",
            "city": "VACAVILLE",
            "state": "CA",
            "postal_code": "956889494",
            "telephone_number": "707-453-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILD",
        "first_name": "TIMOTHY",
        "middle_name": "W.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2021-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": "A61573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1 Quality Dr",
            "city": "Vacaville",
            "state": "CA",
            "country_code": "US",
            "postal_code": "956889494",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Vacaville, CA

Sources for this page

Verify at the official NPI Registry.