Individual provider Active NPI

Ian Wilds

  • Emergency Medicine Physician
  • Indian Trail, NC
National Provider Identifier
1972711562
Registry record updated Feb 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
2010-01910 Issued in NC
Practice address
6030 W Highway 74
Suite a
Indian Trail, NC 28079-3468
Phone
(704) 246-2777
NPI assigned
May 18, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 2010-01910 NC Primary

Addresses

Primary practice location

6030 W Highway 74
Suite a
Indian Trail, NC 28079-3468

Mailing address

6030 W Highway 74
Indian Trail, NC 28079-3468

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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

Enrollment IDStateProvider typePAC IDDetails
I20110124000162 NC Practitioner - Emergency Medicine 0648344366 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Wayne State University School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carolinas Physicians Network IncGroup PAC ID 3375449655, 2,324 clinicians

Practice addresses (Care Compare)

6030 W Hwy 74
Suite D
Indian Trail, NC 28079-3469
Phone (704) 863-4878

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94 of 100Reported as apm
Quality
81.63
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2010-01910NCMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Physicians Network Inc Current Accepting new patients
Carolinas Physicians Network Inc CurrentSince Jul 6, 2015 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Jul 6, 2015 Accepting new patients
Emergency Medicine Physicians of Iredell County, PLLC Emergency Medicine Past Accepting new patients

Locations

14214 Ballantyne Lake Rd
Ste 100
Charlotte, NC 28277
Phone (704) 667-2650

9332 S Tryon St
Charlotte, NC 28273
Phone (704) 587-6700

14214 Ballantyne Lake Rd
Ste 300
Charlotte, NC 28277
Phone (704) 446-5070

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

7810 Providence Rd
Ste 102
Charlotte, NC 28226
Phone (704) 393-4808

10628 Park Rd
Charlotte, NC 28210
Phone (704) 543-2000

2001 Vail Ave
Charlotte, NC 28207
Phone (704) 304-5000

5717 Albemarle Rd
Charlotte, NC 28212
Phone (704) 563-2150

6030 W Highway 74
Ste D
Indian Trail, NC 28079
Phone (704) 226-0413

6030 W Highway 74
Ste A
Indian Trail, NC 28079
Phone (704) 246-2777

6030 W Highway 74
Indian Trail, NC 28079
Phone (704) 246-2777

557 Brookdale Dr
Statesville, NC 28677
Phone (330) 445-4361

Interoperability endpoints

  • Direct secure messaging: iwilds500030@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 4

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549929600000",
    "number": "1972711562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6030 W HIGHWAY 74",
            "city": "INDIAN TRAIL",
            "state": "NC",
            "postal_code": "280793468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6030 W HIGHWAY 74",
            "address_2": "SUITE A",
            "city": "INDIAN TRAIL",
            "state": "NC",
            "postal_code": "280793468",
            "telephone_number": "704-246-2777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDS",
        "first_name": "IAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-18",
        "last_updated": "2019-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "2010-01910",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indian Trail, NC

Sources for this page

Verify at the official NPI Registry.