Jennifer Marie Wild, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD 60455588 Issued in WA

Practice address

12800 Bothell Everett Hwy
Everett, WA 98208-6642

Phone

(425) 316-5188

Fax

(425) 225-1005

NPI assigned

Mar 31, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Providence Health & Services- Washington

  • General Practice Physician
  • Everett, WA
  • NPI 1124270715
  Medicare reassignment NPD
• Seattle Children'S Hospital

  • Specialist
  • Seattle, WA
  • NPI 1003319500
  Medicare reassignment NPD
• The Association of Chrmc and University Physicians

  • Pediatrics Physician
  • Seattle, WA
  • NPI 1255449963
  Medicare reassignment NPD
• Association of CHMC and University Physicians

  • Pediatrics Physician
  • Richland, WA
  • NPI 1851680664
  NPD
• Providence Health & Services - Washington

  • General Practice Physician
  • Snohomish, WA
  • NPI 1770877227
  NPD
• Seattle Childrens Hospital

  • Clinic Pharmacy
  • Seattle, WA
  • NPI 1245342153
  NPD
• Providence Health & Services - Washington

  • General Practice Physician
  • Everett, WA
  • NPI 1013169507

  Pediatrics

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1301529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619654400000",
    "number": "1588953582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3360",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083360",
            "telephone_number": "866-366-2983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12800 BOTHELL EVERETT HWY",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982086642",
            "telephone_number": "425-316-5188",
            "fax_number": "425-225-1005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILD",
        "first_name": "JENNIFER",
        "middle_name": "MARIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-31",
        "last_updated": "2021-04-29",
        "certification_date": "2021-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD 60455588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jwild534716@wm.providencedirect.org",
            "affiliation": "N",
            "address_1": "12800 Bothell Everett Hwy",
            "city": "Everett",
            "state": "WA",
            "country_code": "US",
            "postal_code": "982086642",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mark H Wilber, MSW, AAC-R
• Kristin Louise Wilcox, CNP
• Lilia Wilcox
• Ronel Kay Wilcox, RN
• Carrie Ann Wilcoxen, COUNSELOR
• Terra Wilde, DNP
• Allison Wildeman
• Jessica Wilder
• Heidi Christina Wiley
• Samantha K Wilford, RDN

• Pediatrics Physician in Everett, WA
• Providers in Everett, WA by specialty
• Pediatrics Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.