Wild Prairie Primary Care PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

WILD PRAIRIE PRIMARY CARE PLLC

Practice address

240 Mechanic St Ste 201
Lebanon, NH 03766-2617

Phone

(971) 235-9657

NPI assigned

Jul 28, 2025

Organization subpart

No

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

Authorized official

Name

Juniper Vale, MDNPI 1427931542

Title

Owner

Phone

(603) 727-9175

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NH

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Juniper Mae Vale, MD

  • Internal Medicine Physician
  • Lebanon, NH
  • NPI 1427931542
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1753660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760745600000",
    "number": "1720961865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 MECHANIC ST STE 201",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "037662617",
            "telephone_number": "603-727-9175",
            "fax_number": "603-988-0711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 MECHANIC ST STE 201",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "037662617",
            "telephone_number": "971-235-9657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILD PRAIRIE PRIMARY CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-28",
        "last_updated": "2025-10-18",
        "certification_date": "2025-10-18",
        "status": "A",
        "authorized_official_last_name": "VALE",
        "authorized_official_first_name": "JUNIPER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "603-727-9175",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Mark Whittaker, CRNA
• Shana A Wierchowski, MD
• Billie Wiggins, MD
• Allison Wilcox, M.D.
• David Wilcox, MD
• Elizabeth I Wilder, CRNA
• Ashley Therese Wildman, DO
• Gregory Wildman
• Christopher Waitt Wiley, M.D.
• Ivy Wilkinson-Ryan, MD

• Internal Medicine Physician in Lebanon, NH
• Providers in Lebanon, NH by specialty
• Internal Medicine Physician in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.