NPIMap

Individual provider Active NPI

Carolyn A Wild, MD

  • Hematology & Oncology Physician
  • Gig Harbor, WA
National Provider Identifier
1871581041
Registry record updated Feb 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
MD60112482 Issued in WA
Practice address
4545 Point Fosdick Dr # 215
Gig Harbor, WA 98335-1700
Phone
(253) 530-8060
Fax
(253) 530-8062
NPI assigned
Oct 11, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 23, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology (Internal Medicine) Physician 207RH0000X MD60112482 WA
Hematology & Oncology Physician 207RH0003X 60112482 WA
Medical Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RX0202X MD60112482 WA
Hematology & Oncology Physician 207RH0003X MD60112482 WA Primary

Addresses

Primary practice location

4545 Point Fosdick Dr # 215
Gig Harbor, WA 98335-1700

Mailing address

4545 Point Fosdick Dr # 215
Gig Harbor, WA 98335-1700
Phone (253) 530-8060

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100908000567 WA Practitioner - Hematology/Oncology 2466576855 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Uniformed Services Uhs Fe Hebert School of Med, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

10452 Silverdale Way NW
Silverdale, WA 98383-9411
Phone (360) 307-7300

1400 Pottery Ave
Port Orchard, WA 98366-3711
Phone (360) 895-5000

700 Lilly Rd NE
Olympia, WA 98506-5115
Phone (360) 923-7000

9505 S Steele St
Tacoma, WA 98444-1858
Phone (253) 597-6800

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
60112482WAMDHematology & Oncology Physician
MD60112482WAMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System Multi-Specialty Current Accepting new patients
Multicare Health System CurrentSince Aug 3, 2020 Accepting new patients
Kaiser Foundation Health Plan of Washington CurrentSince May 11, 2013 Accepting new patients
Kaiser Foundation Health Plan of Washington Multi-Specialty Current Accepting new patients
Kaiser Foundation Health Plan of Washington Multi-Specialty CurrentSince May 11, 2013 Accepting new patients
Multicare Health System Multi-Specialty CurrentSince Aug 3, 2020 Accepting new patients
Rockwood Clinic PS Multi-Specialty PastSince Mar 4, 2021 Accepting new patients
Multicare Health System Multi-Specialty PastSince Mar 4, 2021 Accepting new patients
Northwest Medical Specialties PLLC Multi-Specialty PastSince Apr 1, 2022 Accepting new patients
Northwest Medical Specialties Pharmacy Past Accepting new patients

Locations

4545 Point Fosdick Dr
#215
Gig Harbor, WA 98335
Phone (253) 530-8060

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

19379 7th Ave NE
Poulsbo, WA 98370
Phone (360) 394-1000

200 15th Ave E
Seattle, WA 98112
Phone (206) 326-4530

311 S L St
Tacoma, WA 98405
Phone (253) 403-1444

315 S K St
Tacoma, WA 98405
Phone (253) 403-1291

9505 S Steele St
Tacoma, WA 98444
Phone (253) 597-6800

Interoperability endpoints

  • Direct secure messaging: cwild491997@direct.multicare.org
  • Direct secure messaging: cwild118762@ghc.direct-ci.net

Organizations & group practices 10

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614038400000",
    "number": "1871581041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4545 POINT FOSDICK DR # 215",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983351700",
            "telephone_number": "253-530-8060",
            "fax_number": "253-530-8062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4545 POINT FOSDICK DR # 215",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983351700",
            "telephone_number": "253-530-8060",
            "fax_number": "253-530-8062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILD",
        "first_name": "CAROLYN",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-10-11",
        "last_updated": "2021-02-23",
        "certification_date": "2021-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology",
            "state": "WA",
            "license": "MD60112482",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "WA",
            "license": "60112482",
            "primary": false
        },
        {
            "code": "207RX0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "WA",
            "license": "MD60112482",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "WA",
            "license": "MD60112482",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gig Harbor, WA

Sources for this page

Verify at the official NPI Registry.