Individual provider Active NPI

Richard J. Wilbur, M.D.

  • Internal Medicine Physician
  • Hollywood, FL
National Provider Identifier
1770563348
Registry record updated Sep 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
ME0044134 Issued in FL
Practice address
4050 Sheridan Street
Ste. D
Hollywood, FL 33021-3561
Phone
(954) 989-7441
Fax
(954) 989-7454
NPI assigned
Jan 19, 2006
Last updated
Sep 7, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X ME0044134 FL Primary

Addresses

Primary practice location

4050 Sheridan Street
Ste. D
Hollywood, FL 33021-3561

Mailing address

1117 E Hallandale Beach Blvd
Hallandale Beach, FL 33009-4488
Phone (954) 454-6300

Other identifiers 1

IdentifierTypeStateIssuer
ME0044134OtherFLSTATE LICENSE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081117000770 FL Practitioner - Internal Medicine 8224078746 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME0044134FLMDInternal Medicine Physician

Organizations & group practices 1

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": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346976000000",
    "number": "1770563348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1117 E HALLANDALE BEACH BLVD",
            "city": "HALLANDALE BEACH",
            "state": "FL",
            "postal_code": "330094488",
            "telephone_number": "954-454-6300",
            "fax_number": "954-266-4006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4050 SHERIDAN STREET",
            "address_2": "STE. D",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330213561",
            "telephone_number": "954-989-7441",
            "fax_number": "954-989-7454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILBUR",
        "first_name": "RICHARD",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-19",
        "last_updated": "2012-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME0044134",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "ME0044134",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hollywood, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2012; 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.