Robert Lee Wilder Jr., LCSW-A

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P0134665 Issued in NC

Practice address

200 Tarpon TRL
Jacksonville, NC 28546-5287

Phone

(910) 938-1114

Fax

(910) 938-1118

NPI assigned

Jul 11, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Pine Ridge Indian Health Service Hospital

  • Clinic/Center
  • Martin, SD
  • NPI 1003208257
  NPD
• Pine Ridge Indian Health Service Hospital

  • Clinic/Center
  • Kyle, SD
  • NPI 1003963497
  NPD
• Pine Ridge Indian Health Service Hospital

  • Clinic/Center
  • Manderson, SD
  • NPI 1487701348
  NPD
• Pine Ridge Indian Health Service Hospital

  • General Acute Care Hospital
  • Pine Ridge, SD
  • NPI 1497786412
  NPD
• Pine Ridge Indian Health Service Hospital

  • Clinic/Center
  • Wanblee, SD
  • NPI 1962559518
  NPD

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

{
    "created_epoch": "1562803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562803200000",
    "number": "1770135519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 TARPON TRL",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285465287",
            "telephone_number": "910-938-1114",
            "fax_number": "910-938-1118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 TARPON TRL",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285465287",
            "telephone_number": "910-938-1114",
            "fax_number": "910-938-1118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDER",
        "first_name": "ROBERT",
        "middle_name": "LEE",
        "name_suffix": "Jr.",
        "credential": "LCSW-A",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-11",
        "last_updated": "2019-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P0134665",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ann-Marie Arlene Whittaker, LMBT
• Cassidy Michelle Whoolery, LMBT
• Victoria Wicker
• Kelsey M.S. Wieduwilt, PT, DPT
• Jack Earl Wilcox, NURSE PRACTITIONER
• Meghan Elizabeth Wilker, MS
• Williams Outreach & Consulting Inc
• Natalie B Williams Tayman
• Angela Price Williams, CRNA
• Ashley Williams, DNP, AGNP

• Clinical Social Worker in Jacksonville, NC
• Providers in Jacksonville, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.