Tracy Wilde

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1509 Issued in SC

Practice address

719B SE Main St
Simpsonville, SC 29681-3237

Phone

(864) 963-9229

NPI assigned

Sep 20, 2006

Sex

Female

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 SC

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

University of North Carolina at Chapel Hill School of Medicine, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Elite Integrated Therapy Centers LLCGroup PAC ID 3274552716, 51 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.

• Elite Integrated Therapy Centers, LLC

  • Physical Therapist
  • Greenville, SC
  • NPI 1184673600
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1962509018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "719B SE MAIN ST",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296813237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719B SE MAIN ST",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296813237",
            "telephone_number": "864-963-9229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDE",
        "first_name": "TRACY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "1509",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER NUMBER",
            "identifier": "7796338",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wendelyn White
• Katie Elizabeth Whiten, PA-C
• Charles W Whittenberg, MD
• Richard Widener
• Samantha Wiechec
• Jay Wiles, PSY.D.
• Nicole Wilkerson, OTR/L
• Ronnie Wilkins
• Bucky Williams-Hooker, R.N.
• Brian Williams, M.A., PSY.S.

• Physical Therapist in Simpsonville, SC
• Providers in Simpsonville, SC by specialty
• Physical Therapist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.