Jackson Wild, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

112750 Issued in MA

Practice address

75 Francis St
Boston, MA 02115-6110

Phone

(617) 732-5500

NPI assigned

Jan 11, 2017

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

Medicare fee-for-service enrollment

Enrolled in MA, NH2 enrollments

Enrollment records 2

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Virginia Commonwealth University, School of Medicine, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Integrated Gastroenterology Consultants, P.C.Group PAC ID 0941260897, 35 clinicians

Winchester Anesthesia Associates, IncGroup PAC ID 7315977196, 64 clinicians

Dha Endoscopy LLCGroup PAC ID 4082614979, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Dha Endoscopy LLC

  • Anesthesiology Physician
  • Stoneham, MA
  • NPI 1851921555
  Medicare reassignment Care Compare group NPD
• Winchester Anesthesia Associates, Inc

  • Pain Medicine (Anesthesiology) Physician
  • Winchester, MA
  • NPI 1972626117
  Medicare reassignment Care Compare group NPD
• Integrated Gastroenterology Consultants, PC

  • Physical Therapist
  • North Chelmsford, MA
  • NPI 1396075123
  Medicare reassignment Care Compare group
• Associated Physicians of Harvard Medical Faculty Physicians at Beth Is

  • Diagnostic Radiology Physician
  • Milton, MA
  • NPI 1245773308
  Medicare reassignment NPD
• Brigham & Womens Physicians Organization Inc

  • Internal Medicine Physician
  • Boston, MA
  • NPI 1033535497
  Medicare reassignment NPD
• Gbaa Holdings, PLLC

  • Anesthesiology Physician
  • Acton, MA
  • NPI 1790299592

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Winchester Anesthesia Associates 2 Inc

  • Anesthesiology Physician
  • Winchester, MA
  • NPI 1427599588
  Medicare reassignment NPD
• Mass General Brigham Medical Group, Inc.

  • Internal Medicine Physician
  • Salem, NH
  • NPI 1083360200
  Medicare reassignment NPD
• Associated Physicians of Harvard Medical Faculty Physicians at Beth Is

  • Anesthesiology Physician
  • Plymouth, MA
  • NPI 1568859643
  NPD
• Associated Physicians of Harvard Medical Faculty Physicians at Beth Is

  • Multi-Specialty Clinic/Center
  • Boston, MA
  • NPI 1861216038
  NPD
• Dha Endoscopy LLC

  • Ambulatory Surgical Clinic/Center
  • Stoneham, MA
  • NPI 1730113325
  NPD (past)
• Mass General Brigham Amsurg Inc.

  • Ambulatory Surgical Clinic/Center
  • Salem, NH
  • NPI 1275281370
  NPD (past)

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

{
    "created_epoch": "1484092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484092800000",
    "number": "1952847162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 FRANCIS ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021156110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 FRANCIS ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021156110",
            "telephone_number": "617-732-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILD",
        "first_name": "JACKSON",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-01-11",
        "last_updated": "2017-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MA",
            "license": "112750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsey Wilchynski, PA-C
• Lorna Wilcox-Gollop, RN
• Douglas Robert Wilcox, MD, PHD
• Reginald Burns Wilcox III, PT, DPT, MS, OCS
• Thomas Andrew Wilcoxon, MD
• Nikolas Sandquist Wilde, PA-C
• Elisabeth J. Wilder, M.D.
• Fatima G Wilder, M.D.
• Jayme Lynn Wilder, MD
• Lindsey Wilder, MED

• Certified Registered Nurse Anesthetist in Boston, MA
• Providers in Boston, MA by specialty
• Certified Registered Nurse Anesthetist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.