Active NPI
Mary Wildner, PA-C, MPH
- Physician Assistant
- Vienna, VA
National Provider Identifier
1740915289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0110008752
- Practice address
- 2110 Gallows Rd Ste D
Vienna, VA 22182-3962 - Phone
- (703) 592-4600
- NPI assigned
- Jul 19, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0110008752 | VA | Primary |
Addresses
Primary practice location
2110 Gallows Rd Ste D
Vienna, VA 22182-3962
Mailing address
2110 Gallows Rd Ste D
Vienna, VA 22182-3962
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC, VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
4520 E W Hwy
Suite 775
Bethesda, MD 20814-0066
Phone (410) 823-6408
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Neta, Inc. | Past | Accepting new patients |
Interoperability endpoints
- bloomhealthcenters.marywildner@131200.advancedmd-direct.com
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.
-
- Child & Adolescent Psychiatry Physician
- Arlington, VA
- NPI 1134506520
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1658188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666828800000",
"number": "1740915289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2110 GALLOWS RD STE D",
"city": "VIENNA",
"state": "VA",
"postal_code": "221823962"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2110 GALLOWS RD STE D",
"city": "VIENNA",
"state": "VA",
"postal_code": "221823962",
"telephone_number": "703-592-4600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILDNER",
"first_name": "MARY",
"credential": "PA-C, MPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-07-19",
"last_updated": "2022-10-27",
"certification_date": "2022-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "VA",
"license": "0110008752",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vienna, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2022; 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.