NPIMap

Individual provider Active NPI

Robert Stephen Wade, M.D.

  • Pediatrics Physician
  • Perry, GA
National Provider Identifier
1659329753
Registry record updated Jul 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
031350 Issued in GA
Practice address
1118 Morningside Dr
Suite a
Perry, GA 31069-4948
Phone
(478) 988-2205
Fax
(478) 988-2201
NPI assigned
May 4, 2006
Last updated
Jul 22, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 031350 GA Primary

Addresses

Primary practice location

1118 Morningside Dr
Suite a
Perry, GA 31069-4948

Mailing address

233 N Houston Rd
Suite 140-H
Warner Robins, GA 31093-3074
Phone (478) 923-3360

Other identifiers 1

IdentifierTypeStateIssuer
00377836DMedicaidGA

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 Medicine

State licenses

LicenseStateTypeSpecialty
031350GAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Youthcare,PC Pediatrics Past Accepting new patients
Youthcare Pediatrics of Central Georgia, PC Pediatrics Past Accepting new patients
Houston Hospitals Inc Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216684800000",
    "number": "1659329753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "233 N HOUSTON RD",
            "address_2": "SUITE 140-H",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310933074",
            "telephone_number": "478-923-3360",
            "fax_number": "478-923-9977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1118 MORNINGSIDE DR",
            "address_2": "SUITE A",
            "city": "PERRY",
            "state": "GA",
            "postal_code": "310694948",
            "telephone_number": "478-988-2205",
            "fax_number": "478-988-2201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADE",
        "first_name": "ROBERT",
        "middle_name": "STEPHEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-04",
        "last_updated": "2008-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "031350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00377836D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Perry, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.