Individual provider Active NPI

Trisha J Wilder, PA-C

  • Medical Physician Assistant
  • Bend, OR
National Provider Identifier
1609154517
Registry record updated Dec 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA21676 Issued in CA
Practice address
61250 SE Coombs PL
Bend, OR 97702-3704
Phone
(541) 706-5930
Fax
(541) 706-5931
NPI assigned
Jul 26, 2011
Last updated
Dec 3, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA21676 CA Primary

Addresses

Primary practice location

61250 SE Coombs PL
Bend, OR 97702-3704

Mailing address

1236 NW Baltimore Ave
Bend, OR 97703-3125
Phone (530) 526-3218

Other practice location 1

1742 Oregon St
Redding, CA 96001-1717
Phone (530) 526-3218

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address twilder199089@secure.stcharleshealthcare.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, OR2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140304001908 CA Practitioner - Physician Assistant 2264666031 Reassigns benefits to 2 organizations
I20240428000102 OR Practitioner - Physician Assistant 2264666031 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of California, Davis School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Charles Health System IncGroup PAC ID 8729111513, 379 clinicians

Practice addresses (Care Compare)

211 NW Larch Ave
Family Care
Redmond, OR 97756-1357
Phone (541) 548-2164

51781 Huntington Rd
La Pine, OR 97739-1118
Phone (541) 666-7920

61250 SE Coombs PL
Family Care Clin
Bend, OR 97702-3704
Phone (541) 706-5935

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA21676CAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St. Charles Health System, Inc. CurrentSince Aug 26, 2024 Accepting new patients
Icco LLC CurrentSince Apr 22, 2024 Accepting new patients
Icco, LLC CurrentSince Apr 22, 2024 Accepting new patients
Cep America - California CurrentSince Sep 1, 2014 Accepting new patients
Cep America-California CurrentSince Sep 1, 2014 Accepting new patients
St. Charles Health System, Inc. CurrentSince Aug 26, 2024 Accepting new patients
Apogee Outpatient Surgery Center Past Accepting new patients
Rainbow Basin Emergency Physicians, a Medical Corporation Past Accepting new patients
Premier Emergency Physicians of California Medical Group PC Past Accepting new patients
St. Charles Health System, Inc. Past Accepting new patients

Locations

800 E Washington Blvd
Crescent City, CA 95531
Phone (707) 464-8511

1205 E North St
Manteca, CA 95336
Phone (209) 239-8301

726 4th St
Marysville, CA 95901
Phone (530) 491-9491

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 350-2663

825 Delbon Ave
Turlock, CA 95382
Phone (209) 664-2744

29358 Network Pl
Chicago, IL 60673

61250 SE Coombs Pl
Bend, OR 97702
Phone (541) 706-5930

598 E 13th Ave
Eugene, OR 97401
Phone (541) 636-3473

3675 Pacific Ave
#101
Forest Grove, OR 97116
Phone (971) 762-4611

1890 NW 6th St
Grants Pass, OR 97526
Phone (541) 507-0684

3737 Shasta Way
Ste A
Klamath Falls, OR 97603
Phone (541) 883-2337

3400 Cooperative Way
Lebanon, OR 97355
Phone (541) 333-6605

384 SE Combs Flat Rd
Prineville, OR 97754
Phone (541) 383-3668

211 NW Larch Ave
Redmond, OR 97756
Phone (541) 548-2164

3818 SW 21st St
Ste 100
Redmond, OR 97756
Phone (541) 548-2899

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1311638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733184000000",
    "number": "1609154517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1236 NW BALTIMORE AVE",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977033125",
            "telephone_number": "530-526-3218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61250 SE COOMBS PL",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977023704",
            "telephone_number": "541-706-5930",
            "fax_number": "541-706-5931"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1742 Oregon St",
            "address_purpose": "LOCATION",
            "city": "Redding",
            "state": "CA",
            "postal_code": "960011717",
            "country_code": "US",
            "telephone_number": "530-526-3218",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILDER",
        "first_name": "TRISHA",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-26",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA21676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "twilder199089@secure.stcharleshealthcare.org",
            "affiliation": "N",
            "address_1": "61250 SE Coombs Pl",
            "city": "Bend",
            "state": "OR",
            "country_code": "US",
            "postal_code": "977023704",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

Verify at the official NPI Registry.