Individual provider Active NPI

Lee Rose Wilde

  • Obstetrics & Gynecology Physician
  • Flagstaff, AZ
National Provider Identifier
1700101060
Registry record updated May 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
00821 Issued in AZ
Practice address
2920 N 4TH St
Flagstaff, AZ 86004-1816
Phone
(928) 522-9400
Fax
(928) 522-9736
NPI assigned
Mar 30, 2010
Last updated
May 12, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 00821 AZ Primary

Addresses

Primary practice location

2920 N 4TH St
Flagstaff, AZ 86004-1816

Mailing address

PO Box 1231
Tucson, AZ 85702-1231
Phone (520) 670-3909

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, AZ, OR3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20141002001974 TX Practitioner - Obstetrics/Gynecology 1052554847 Reassigns benefits to 1 organization
I20191224000580 AZ Practitioner - Obstetrics/Gynecology 1052554847 Reassigns benefits to 2 organizations
I20240930002474 OR Practitioner - Obstetrics/Gynecology 1052554847 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Country Healthcare IncGroup PAC ID 8820981053, 20 clinicians

Practice addresses (Care Compare)

2920 N 4TH St
Flagstaff, AZ 86004-1816

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
77.59 of 100Reported as group
Quality
47.51
Promoting interoperability
69
Improvement activities
40
Cost
86.96

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
00821AZMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Country Healthcare, Inc. CurrentSince Dec 1, 2019 Accepting new patients
Northwest Medical Foundation of Tillamook CurrentSince Aug 15, 2024 Accepting new patients
Summit Healthcare Medical Associates CurrentSince Dec 1, 2024 Accepting new patients
North Country Healthcare, Inc. Current Accepting new patients
North Country Healthcare, Inc. CurrentSince Dec 1, 2019 Accepting new patients
Summit Healthcare Medical Associates Obstetrics & Gynecology Current Accepting new patients
Tuba City Regional Health Care Corporation Obstetrics & Gynecology CurrentSince Aug 11, 2014 Accepting new patients
North Country Healthcare, Inc. Current Accepting new patients
Tuba City Regional Health Care Corporation CurrentSince Aug 11, 2014 Accepting new patients
Northwest Medical Foundation of Tillamook CurrentSince Aug 15, 2024 Accepting new patients
Northwest Medical Foundation of Tillamook CurrentSince Jan 1, 2026 Accepting new patients
Summit Healthcare Medical Associates CurrentSince Dec 1, 2024 Accepting new patients
Summit Healthcare Association Past Accepting new patients
Flagstaff Medical Center Past Accepting new patients

Locations

1120 W University Ave
Ste 101
Flagstaff, AZ 86001
Phone (928) 522-1300

2500 N Rose St
Flagstaff, AZ 86004
Phone (928) 213-6121

2920 N 4th St
Flagstaff, AZ 86004
Phone (928) 213-6100

4951 S White Mountain Rd
Bldg A
Show Low, AZ 85901
Phone (928) 532-3926

620 Lee St
Winslow, AZ 86047
Phone (928) 288-8700

1000 3rd St
Tillamook, OR 97141
Phone (503) 251-6129

1000 3rd St
#M
Tillamook, OR 97141
Phone (503) 815-2260

1011 3rd St
Tillamook, OR 97141
Phone (503) 842-2001

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 4

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": "1269907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778544000000",
    "number": "1700101060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1231",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857021231",
            "telephone_number": "520-670-3909",
            "fax_number": "520-309-2560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2920 N 4TH ST",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860041816",
            "telephone_number": "928-522-9400",
            "fax_number": "928-522-9736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDE",
        "first_name": "LEE",
        "middle_name": "ROSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-30",
        "last_updated": "2026-05-12",
        "certification_date": "2026-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "AZ",
            "license": "00821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flagstaff, AZ

Sources for this page

Verify at the official NPI Registry.