Active NPI
Barton William Wild, MD
- Interventional Pain Medicine Physician
- Portage, MI
National Provider Identifier
1710197579
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Interventional Pain Medicine Physician
- License
- 4301086518
- Practice address
- 3770 Glenkerry CT
Portage, MI 49024-0700 - Phone
- (269) 329-2887
- Fax
- (269) 329-2805
- NPI assigned
- May 23, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pain Medicine (Anesthesiology) Physician | 207LP2900X | 4301086518 | MI | |
| Interventional Pain Medicine Physician | 208VP0014X | 4301086518 | MI | Primary |
Addresses
Primary practice location
3770 Glenkerry CT
Portage, MI 49024-0700
Mailing address
5555 Glenwood Hills Pkwy SE Ste 2
Grand Rapids, MI 49512-2091
Phone (616) 940-2662
Other practice location 1
105 Winston Dr
Marshall, MI 49068-8525
Phone (269) 781-3561
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710197579 | Medicaid | MI | |
| M91620016 | Other | MI | UHC COMMUNITY PLAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Pain Management
- Education
- Wayne State University School of Medicine, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
105 Winston Dr
Southern Michigan Pain Marshall
Marsahll, MI 49068-8525
Phone 2697813651269781
3770 Glenkerry CT
Portage, MI 49024-0700
Phone (269) 329-2887
Hospital & facility affiliations
- Bronson Methodist Hospital
- Bronson Battle Creek Hospital
- Oaklawn Hospital
- Henry Ford Allegiance Health
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301086518 | MI | MD | Interventional Pain Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Michigan Behavioral Consultants PC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Interventional Pain Medicine Physician
- Portage, MI
- NPI 1538119391
-
- Psychologist
- Grand Rapids, MI
- NPI 1336153220
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Battle Creek, MI
- NPI 1083644579
-
- General Acute Care Hospital
- Kalamazoo, MI
- NPI 1831116441
-
- General Acute Care Hospital
- Marshall, MI
- NPI 1861475360
-
- General Acute Care Hospital
- Jackson, MI
- NPI 1053403402
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620259200000",
"number": "1710197579",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5555 GLENWOOD HILLS PKWY SE STE 2",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495122091",
"telephone_number": "616-940-2662",
"fax_number": "616-940-1965"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3770 GLENKERRY CT",
"city": "PORTAGE",
"state": "MI",
"postal_code": "490240700",
"telephone_number": "269-329-2887",
"fax_number": "269-329-2805"
}
],
"practiceLocations": [
{
"address_1": "105 Winston Dr",
"address_purpose": "LOCATION",
"city": "Marshall",
"state": "MI",
"postal_code": "490688525",
"country_code": "US",
"telephone_number": "269-781-3561",
"fax_number": "269-781-4937",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILD",
"first_name": "BARTON",
"middle_name": "WILLIAM",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-23",
"last_updated": "2021-05-06",
"certification_date": "2021-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "207LP2900X",
"taxonomy_group": "",
"desc": "Anesthesiology, Pain Medicine",
"state": "MI",
"license": "4301086518",
"primary": false
},
{
"code": "208VP0014X",
"taxonomy_group": "",
"desc": "Pain Medicine, Interventional Pain Medicine",
"state": "MI",
"license": "4301086518",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1710197579",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UHC COMMUNITY PLAN",
"identifier": "M91620016",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portage, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.