Individual provider Active NPI

Robert J Wylie, MD

  • Orthopaedic Surgery Physician
  • Whiteriver, AZ
National Provider Identifier
1568436871
Registry record updated Jan 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
18644A Issued in AZ
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

Updated by the provider on Jan 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
241333500OtherOWCP
1629236716MedicaidAZ
286254MedicaidAZ
1780614008MedicaidAZ
AZ0342850OtherAZBLUE CROSS BLUE SHIELD AZ
1871523191MedicaidAZ
1295993376MedicaidAZ

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060111000465 TX Practitioner - Orthopedic Surgery 4082632187 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
82.13 of 100Reported as group
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

LicenseStateTypeSpecialty
18644AAZMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
DHHS IHS Phoenix Area CurrentSince Feb 16, 2012 Accepting new patients
DHHS IHS Phoenix Area CurrentSince Feb 16, 2012 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.

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

Verify at the official NPI Registry.