Active NPI
Alonzo Wilder, PAC
- Physician Assistant
- Livingston, LA
National Provider Identifier
1881635878
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- A10241
- Practice address
- 13960 Florida Blvd
Livingston, LA 70754 - Phone
- (225) 686-0158
- NPI assigned
- Jun 9, 2006
- Last updated
- Jan 27, 2009
- Sex
- Male
- 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 | A10241 | LA | Primary |
Addresses
Primary practice location
13960 Florida Blvd
Livingston, LA 70754
Mailing address
PO Box 261166
Baton Rouge, LA 70826-1166
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1626716 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A10241 | LA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Healthremede, LLC | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Healthremede Family Walk-in Occupational Med Wellness Center
- Primary Care Clinic/Center
- Baton Rouge, LA
- NPI 1316115678
-
- Occupational Medicine Physician
- Baton Rouge, LA
- NPI 1548772957
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233014400000",
"number": "1881635878",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 261166",
"city": "BATON ROUGE",
"state": "LA",
"postal_code": "708261166"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13960 FLORIDA BLVD",
"city": "LIVINGSTON",
"state": "LA",
"postal_code": "70754",
"telephone_number": "225-686-0158"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILDER",
"first_name": "ALONZO",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-09",
"last_updated": "2009-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "LA",
"license": "A10241",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1626716",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Livingston, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 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.