NPIMap

Individual provider Active NPI

Michael Jeffrey Wilderman, MD

  • Vascular Surgery Physician
  • Hackensack, NJ
National Provider Identifier
1497802938
Registry record updated May 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
25MA08569600 Issued in NJ
Practice address
211 Essex St
Suite 102
Hackensack, NJ 07601-3231
Phone
(201) 487-8882
Fax
(201) 487-0943
NPI assigned
Jan 5, 2007
Last updated
May 8, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X 25MA08569600 NJ Primary

Addresses

Primary practice location

211 Essex St
Suite 102
Hackensack, NJ 07601-3231

Mailing address

211 Essex St
Suite 102
Hackensack, NJ 07601-3231
Phone (201) 487-8882

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20090625000398 NJ Practitioner - Vascular SurgeryPractitioner - General Surgery 1254482607 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Vascular SurgeryAlso: General Surgery
Education
Perelman School of Med at the University of Pennsylvania, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bergen Surgical Specialists,P.a.Group PAC ID 0244231215, 6 clinicians
Dmac Vascular Lab LLCGroup PAC ID 4789064718, 2 clinicians

Practice addresses (Care Compare)

211 Essex St
Suite 102
Hackensack, NJ 07601-3244
Phone (201) 487-8882

946 Bloomfield Ave
Suite 1
Glen Ridge, NJ 07028-1308
Phone (973) 743-1121

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.12 of 100Reported as group
Quality
79.58
Improvement activities
40
Cost
58.76

Merit-based Incentive Payment System (MIPS)

Final score
22.72 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
75.72

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)204
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Bergen Surgical Specialists, PA CurrentSince Mar 23, 2010 Accepting new patients
Dmac Vascular Lab LLC CurrentSince Oct 2, 2023 Accepting new patients
Irpus Electrophysiology LLC Current Accepting new patients
Magnus Imaging, LLC Past Accepting new patients

Locations

946 Bloomfield Ave
Lowr
Glen Ridge, NJ 07028
Phone (973) 743-0061

946 Bloomfield Ave
Ste 1
Glen Ridge, NJ 07028
Phone (973) 743-0061

211 Essex St
Ste 102
Hackensack, NJ 07601
Phone (201) 487-8882

Interoperability endpoints

  • Direct secure messaging: mwilderman833418@ahs.direct-ci.com

Organizations & group practices 4

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 7

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": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1399507200000",
    "number": "1497802938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 ESSEX ST",
            "address_2": "SUITE 102",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076013231",
            "telephone_number": "201-487-8882",
            "fax_number": "201-487-0943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 ESSEX ST",
            "address_2": "SUITE 102",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076013231",
            "telephone_number": "201-487-8882",
            "fax_number": "201-487-0943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDERMAN",
        "first_name": "MICHAEL",
        "middle_name": "JEFFREY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-05",
        "last_updated": "2014-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NJ",
            "license": "25MA08569600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hackensack, NJ

Sources for this page

Verify at the official NPI Registry.