Alan P K Wild, MD

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

R9D17 Issued in MO

Practice address

3660 Vista Ave
Ste. 312
Saint Louis, MO 63110

Phone

(314) 977-5110

Fax

(314) 977-5119

NPI assigned

Oct 14, 2005

Last updated

Nov 20, 2009By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: awild426993@direct-ehr-ssmhc.com

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.

• SSM Health Care Group

  dba SLUCare Physician Group

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1306589544

  Otolaryngology

  Medicare reassignment NPD
• SSM Health Care Group

  dba SLUCare Physician Group

  • Dermatopathology Physician
  • Saint Louis, MO
  • NPI 1932844495
  NPD

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

{
    "created_epoch": "1129248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258675200000",
    "number": "1871582692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3635 VISTA AVE",
            "address_2": "P.O. BOX 15250",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631102539",
            "telephone_number": "314-577-8884",
            "fax_number": "314-268-5111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3660 VISTA AVE",
            "address_2": "STE. 312",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "63110",
            "telephone_number": "314-977-5110",
            "fax_number": "314-977-5119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILD",
        "first_name": "ALAN",
        "middle_name": "P K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-14",
        "last_updated": "2009-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MO",
            "license": "R9D17",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "040004991",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Saundra Wilbourn
• Ryan Richard Wilbur, MD
• Jayla C Wilburn
• Melissa S Wilcox-Erard, OD
• Jeffrey Wilcox
• Alexandra Danielle Wild
• Teresa Marie Wild, P.T.
• David N Wilde, M.A., L.P.C.
• Elizabeth Ann Wilde
• Alexandra Danielle Wilder, MD

• Otolaryngology Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Otolaryngology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2009; 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.