NPIMap

Individual provider Active NPI

Mark J Wild, M.D.

  • Internal Medicine Physician
  • Bel Air, MD
National Provider Identifier
1679578207
Registry record updated Dec 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
D35522 Issued in MD
Practice address
2 North Ave
Ste 101
Bel Air, MD 21014-2303
Phone
(410) 838-6434
Fax
(410) 838-4250
NPI assigned
Jun 20, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X D35522 MD Primary

Addresses

Primary practice location

2 North Ave
Ste 101
Bel Air, MD 21014-2303

Mailing address

615 W Macphail Rd
Ste 106
Bel Air, MD 21014-4393
Phone (410) 638-8900

Other identifiers 1

IdentifierTypeStateIssuer
778171700MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050404000699 MD Practitioner - Internal Medicine 1254388010 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Rutgers New Jersey Medical School, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Agape Physical Therapy and Sports Rehabilitation LPGroup PAC ID 3870741390, 684 clinicians
Harford Primary Care LLCGroup PAC ID 3971499971, 27 clinicians

Practice addresses (Care Compare)

12 Newport Dr
Suite a
Forest Hill, MD 21050-1758

622 S Union Ave
Havre de Grace, MD 21078-3422
Phone (410) 939-3770

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D35522MDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Harford Primary Care LLC CurrentSince Jul 1, 1995 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

615 W Macphail Rd
Ste 106
Bel Air, MD 21014
Phone (410) 638-8900

2 North Ave
Ste 101
Bel Air, MD 21014
Phone (410) 296-1661

622 S Union Ave
Hvre de Grace, MD 21078
Phone (410) 939-3770

Interoperability endpoints

  • Direct secure messaging: mwild655720@direct.umm.edu

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 and National Provider Directory roles.

Hospital & facility affiliations 7

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": "1119225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355097600000",
    "number": "1679578207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 W MACPHAIL RD",
            "address_2": "STE 106",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210144393",
            "telephone_number": "410-638-8900",
            "fax_number": "410-638-8915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 NORTH AVE",
            "address_2": "STE 101",
            "city": "BEL AIR",
            "state": "MD",
            "postal_code": "210142303",
            "telephone_number": "410-838-6434",
            "fax_number": "410-838-4250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILD",
        "first_name": "MARK",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-20",
        "last_updated": "2012-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "D35522",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "778171700",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bel Air, MD

Sources for this page

Verify at the official NPI Registry.