Active NPI
Jerold C Wilde, DDS MS
- Periodontics
- Pasco, WA
National Provider Identifier
1588630099
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- DE00009195
- Practice address
- 515 W Court St
Pasco, WA 99301-3737 - Phone
- (509) 547-2204
- NPI assigned
- Feb 24, 2006
- Last updated
- Nov 9, 2011
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | DE00009195 | WA | Primary |
Addresses
Primary practice location
515 W Court St
Pasco, WA 99301-3737
Mailing address
PO Box 1452
Pasco, WA 99301-1223
Phone (509) 547-2204
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160823001776 | WA | Order and Referring Only - Other (Physician) | 0941595433 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140739200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320796800000",
"number": "1588630099",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1452",
"city": "PASCO",
"state": "WA",
"postal_code": "993011223",
"telephone_number": "509-547-2204"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "515 W COURT ST",
"city": "PASCO",
"state": "WA",
"postal_code": "993013737",
"telephone_number": "509-547-2204"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILDE",
"first_name": "JEROLD",
"middle_name": "C",
"credential": "DDS MS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-24",
"last_updated": "2011-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "WA",
"license": "DE00009195",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pasco, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2011; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.