Clarence L Wiley Sr., M.D.,M.M.S.,F.A.A.D

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

12980 Issued in OK

Practice address

1211 N Shartel Ave Ste 407
Oklahoma City, OK 73103-2425

Phone

(405) 278-7911

Fax

(405) 278-7925

NPI assigned

Aug 11, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Clarence Lapierce Wiley Sr. Professional name

Medicare fee-for-service enrollment

Enrolled in OK

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

Specialty

Dermatology

Education

Warren Alpert Medical School of Brown University, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Absentee Shawnee Tribal Health Authority, IncGroup PAC ID 5799171088, 83 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Absentee Shawnee Tribal Health Authority, Inc.

  • Multi-Specialty Clinic/Center
  • Shawnee, OK
  • NPI 1942253521
  Medicare reassignment Care Compare group NPD
• Saints Medical Group, LLC

  • Internal Medicine Physician
  • Shawnee, OK
  • NPI 1881648285

  Dermatology

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470268800000",
    "number": "1477564797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2074",
            "city": "LOWELL",
            "state": "AR",
            "postal_code": "727452074",
            "telephone_number": "405-278-7911",
            "fax_number": "405-278-7925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 N SHARTEL AVE STE 407",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731032425",
            "telephone_number": "405-278-7911",
            "fax_number": "405-278-7925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILEY",
        "first_name": "CLARENCE",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "M.D.,M.M.S.,F.A.A.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-11",
        "last_updated": "2016-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "OK",
            "license": "12980",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "243432400",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CLARENCE",
            "last_name": "WILEY",
            "middle_name": "LAPIERCE",
            "prefix": "DR.",
            "suffix": "SR.",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Robert A Wild, MD, PHD, MPH
• Sara B Wilder
• Shanique Wilder
• Wildflower Flame Counseling, PLLC
• Angela M Wiley, BHRS
• Julie Louise Wiley, D.O.
• Kelly Lynn Wiley
• Kevin Frank Wiley, MD
• Mary Katherine Wiley, M.S.
• Christopher David Wilhelm, MD

• Dermatology Physician in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Dermatology Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2016; 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.

Verify at the official NPI Registry.