Active NPI
Robert J Wylie, MD
- Orthopaedic Surgery Physician
- Whiteriver, AZ
National Provider Identifier
1568436871
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- 18644A
- Practice address
- 200 West Hospital Drive
Whiteriver, AZ 85941-0860 - Phone
- (928) 338-4911
- Fax
- (928) 338-5508
- NPI assigned
- Feb 14, 2006
- 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 |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 18644A | AZ | Primary |
Addresses
Primary practice location
200 West Hospital Drive
Whiteriver, AZ 85941-0860
Mailing address
PO Box 860
Whiteriver, AZ 85941-0860
Phone (928) 338-4911
Other practice location 1
107 E Oak Ave
Flagstaff, AZ 86001-1818
Phone (928) 779-7880
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 241333500 | Other | OWCP | |
| 1629236716 | Medicaid | AZ | |
| 286254 | Medicaid | AZ | |
| 1780614008 | Medicaid | AZ | |
| AZ0342850 | Other | AZ | BLUE CROSS BLUE SHIELD AZ |
| 1871523191 | Medicaid | AZ | |
| 1295993376 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care CompareMerit-based Incentive Payment System (MIPS)
- Final score
- 82.13 of 100
- Quality
- 66.85
- Promoting interoperability
- 99
- Improvement activities
- 40
- Cost
- 74.4
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18644A | AZ | MD | Orthopaedic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DHHS IHS Phoenix Area | Current | Accepting new patients | |
| DHHS IHS Phoenix Area | Current | Accepting new patients |
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 and National Provider Directory roles.
-
- Clinic/Center
- Cibecue, AZ
- NPI 1427335181
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610668800000",
"number": "1568436871",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 860",
"city": "WHITERIVER",
"state": "AZ",
"postal_code": "859410860",
"telephone_number": "928-338-4911",
"fax_number": "928-338-5508"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 WEST HOSPITAL DRIVE",
"city": "WHITERIVER",
"state": "AZ",
"postal_code": "859410860",
"telephone_number": "928-338-4911",
"fax_number": "928-338-5508"
}
],
"practiceLocations": [
{
"address_1": "107 E Oak Ave",
"address_purpose": "LOCATION",
"city": "Flagstaff",
"state": "AZ",
"postal_code": "860011818",
"country_code": "US",
"telephone_number": "928-779-7880",
"fax_number": "928-779-7895",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WYLIE",
"first_name": "ROBERT",
"middle_name": "J",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-14",
"last_updated": "2021-01-15",
"certification_date": "2021-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "AZ",
"license": "18644A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OWCP",
"identifier": "241333500",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1629236716",
"state": "AZ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "286254",
"state": "AZ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1780614008",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD AZ",
"identifier": "AZ0342850",
"state": "AZ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1871523191",
"state": "AZ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1295993376",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Whiteriver, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2021; 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.