Active NPI
Christopher Robin Wilder, PH.D.
- Professional Counselor
- Waco, TX
National Provider Identifier
1588033849
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 10850
- Practice address
- 2304 Marketplace Dr
Waco, TX 76711-2467 - Phone
- (254) 202-7300
- Fax
- (254) 202-7350
- NPI assigned
- Sep 16, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 10850 | TX | Primary |
Addresses
Primary practice location
2304 Marketplace Dr
Waco, TX 76711-2467
Mailing address
PO Box 848476
Dallas, TX 75284-8476
Phone (254) 202-4655
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588033849 | Other | TX | NPPES |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | cwilder502286@direct.sw.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10850 | TX | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hillcrest Family Health Center | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Waco, TX
- NPI 1891796694
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598918400000",
"number": "1588033849",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 848476",
"city": "DALLAS",
"state": "TX",
"postal_code": "752848476",
"telephone_number": "254-202-4655",
"fax_number": "254-202-4697"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2304 MARKETPLACE DR",
"city": "WACO",
"state": "TX",
"postal_code": "767112467",
"telephone_number": "254-202-7300",
"fax_number": "254-202-7350"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILDER",
"first_name": "CHRISTOPHER",
"middle_name": "ROBIN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-09-16",
"last_updated": "2020-09-01",
"certification_date": "2020-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "10850",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPPES",
"identifier": "1588033849",
"state": "TX"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "cwilder502286@direct.sw.org",
"affiliation": "N",
"address_1": "2304 Marketplace Dr",
"city": "Waco",
"state": "TX",
"country_code": "US",
"postal_code": "767112467",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Waco, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.