Active NPI
William K Wade, BOCP, COF, C.PED.
- Prosthetist
- Ocean Springs, MS
National Provider Identifier
1902393614
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetist
- License
- C50109
- Practice address
- 3004 Bienville Blvd
Ocean Springs, MS 39564-4370 - Phone
- (228) 875-3828
- Fax
- (228) 436-3580
- NPI assigned
- Apr 18, 2018
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthotist | 222Z00000X | C50109 | MS | |
| Pedorthist | 224L00000X | C50109 | MS | |
| Prosthetist | 224P00000X | C50109 | MS | Primary |
Addresses
Primary practice location
3004 Bienville Blvd
Ocean Springs, MS 39564-4370
Mailing address
3004 Bienville Blvd
Ocean Springs, MS 39564-4370
Phone (228) 875-3828
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C50109 | MS | MD | Pedorthist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| One Source of the Gulf Coast Inc. | Orthotist | Current | Accepting new patients |
| One Source Inc. | Prosthetist | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1524009600000",
"number": "1902393614",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3004 BIENVILLE BLVD",
"city": "OCEAN SPRINGS",
"state": "MS",
"postal_code": "395644370",
"telephone_number": "228-875-3828",
"fax_number": "228-436-3580"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3004 BIENVILLE BLVD",
"city": "OCEAN SPRINGS",
"state": "MS",
"postal_code": "395644370",
"telephone_number": "228-875-3828",
"fax_number": "228-436-3580"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WADE",
"first_name": "WILLIAM",
"middle_name": "K",
"credential": "BOCP, COF, C.PED.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-04-18",
"last_updated": "2018-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "222Z00000X",
"taxonomy_group": "",
"desc": "Orthotist",
"state": "MS",
"license": "C50109",
"primary": false
},
{
"code": "224L00000X",
"taxonomy_group": "",
"desc": "Pedorthist",
"state": "MS",
"license": "C50109",
"primary": false
},
{
"code": "224P00000X",
"taxonomy_group": "",
"desc": "Prosthetist",
"state": "MS",
"license": "C50109",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ocean Springs, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.