Active NPI
Kimberly Diane Wiley, M.D.
- Internal Medicine Physician
- JB Andrews, MD
National Provider Identifier
1982065421
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 30949
- Practice address
- 1060 W Perimeter Rd
JB Andrews, MD 20762-6602 - Phone
- (240) 612-1364
- NPI assigned
- Mar 11, 2016
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 30949 | NE | Primary |
Addresses
Primary practice location
1060 W Perimeter Rd
JB Andrews, MD 20762-6602
Mailing address
2425 E Gate Dr
Silver Spring, MD 20906-2208
Phone (240) 559-7687
Other practice location 1
2200 Bergquist Dr
WHMC/GE-2200Suite 1
JBSA Lackland AFB, TX 78236-5300
Phone (210) 916-5545
Other practice location 2
4494 North Palmer Road
Bethesda, MD 20889-5300
Phone (240) 559-7687
Other names 1
- Dr. Kimberly Diane Stickler
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NE
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210610001028 | NE | Order and Referring Only - Internal Medicine | 7315347572 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1457654400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623110400000",
"number": "1982065421",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2425 E GATE DR",
"city": "SILVER SPRING",
"state": "MD",
"postal_code": "209062208",
"telephone_number": "240-559-7687"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1060 W PERIMETER RD",
"city": "JB ANDREWS",
"state": "MD",
"postal_code": "207626602",
"telephone_number": "240-612-1364"
}
],
"practiceLocations": [
{
"address_1": "2200 Bergquist Dr",
"address_2": "WHMC/GE-2200Suite 1",
"address_purpose": "LOCATION",
"city": "JBSA Lackland AFB",
"state": "TX",
"postal_code": "782365300",
"country_code": "US",
"telephone_number": "210-916-5545",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4494 North Palmer Road",
"address_purpose": "LOCATION",
"city": "Bethesda",
"state": "MD",
"postal_code": "208895300",
"country_code": "US",
"telephone_number": "240-559-7687",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILEY",
"first_name": "KIMBERLY",
"middle_name": "DIANE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-03-11",
"last_updated": "2021-06-08",
"certification_date": "2021-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NE",
"license": "30949",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KIMBERLY",
"last_name": "STICKLER",
"middle_name": "DIANE",
"prefix": "DR.",
"credential": "M.D.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in JB Andrews, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2021; 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.