Individual provider Active NPI

Amber Locklear Wilder, PA-C

  • Medical Physician Assistant
  • New Haven, CT
National Provider Identifier
1720858269
Registry record updated Mar 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
6483 Issued in CT
Practice address
1450 Chapel St
New Haven, CT 06511-4405
Phone
(203) 789-3000
NPI assigned
Jan 5, 2024
Last updated
Mar 15, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 6483 CT
Physician Assistant 363A00000X
Medical Physician Assistant 363AM0700X 6483 CT Primary

Addresses

Primary practice location

1450 Chapel St
New Haven, CT 06511-4405

Mailing address

43 Chestnut St Unit 109
New Haven, CT 06511-5731
Phone (843) 276-2670

Other names 1

  • Amber Kaitlin Locklear Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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 1

Enrollment IDStateProvider typePAC IDDetails
I20240423003997 CT Practitioner - Physician Assistant 4880033836 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Yale UniversityGroup PAC ID 9436061736, 2,632 clinicians

Practice addresses (Care Compare)

1450 Chapel St B
New Haven, CT 06511-4405
Phone 20386754204405

800 Howard Ave
New Haven, CT 06519-1369
Phone (203) 785-2140

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Yale University Psychiatry CurrentSince Apr 4, 2024 Accepting new patients
Yale University CurrentSince Apr 4, 2024 Accepting new patients

Locations

1450 Chapel St
New Haven, CT 06511
Phone (203) 789-3151

50 Division St
New Haven, CT 06511
Phone (203) 785-2140

800 Howard Ave
New Haven, CT 06519
Phone (203) 785-2140

Interoperability endpoints

  • Direct secure messaging: awilder526991@direct.ynhh.org

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, 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": "1704412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710460800000",
    "number": "1720858269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 CHESTNUT ST UNIT 109",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065115731",
            "telephone_number": "843-276-2670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 CHAPEL ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065114405",
            "telephone_number": "203-789-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDER",
        "first_name": "AMBER",
        "middle_name": "LOCKLEAR",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-05",
        "last_updated": "2024-03-15",
        "certification_date": "2024-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CT",
            "license": "6483",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "6483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMBER",
            "last_name": "LOCKLEAR",
            "middle_name": "KAITLIN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in New Haven, CT

Sources for this page

Verify at the official NPI Registry.