WYLDER SHEPHERD FONDAW PA
NPI 1205450400
Physician Assistant in Greensboro, NC

Q: What is Wylder Fondaw's NPI number?

The NPI number for Wylder Fondaw is 1205450400. It was assigned to this individual provider in the NPPES registry on June 3, 2020.

Q: What is Wylder Fondaw's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Wylder Fondaw was last updated on July 18, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since June 03, 2020PECOS Enrolled

75/100

CMS Quality Rating

1126 N CHURCH ST, GREENSBORO, NC 27401(336) 832-7000 Get Directions Write a Review

NPPES record last updated: July 18, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jul 18, 2023, Jun 3, 2020 (2 updates tracked since 2020).

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About Wylder Shepherd Fondaw Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WYLDER SHEPHERD FONDAW PA (NPI 1205450400) is an individual physician assistant in Greensboro, North Carolina, licensed in North Carolina (0010-10234) and active in the NPI registry since June 2020. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1205450400

Entity TypeIndividualMale

Primary Taxonomy363A00000X

Provider Legal NameWYLDER SHEPHERD FONDAWCredential: PA

Location Address1126 N CHURCH STGreensboro, NC 27401-1000

Mailing Address1601 Seward DrJohnson City, TN 37604-7143 · (828) 231-3564

Phone(336) 832-7000

Sole ProprietorNo

Enumeration DateJune 3, 2020

Last NPPES UpdateJuly 18, 20232 updates tracked since enumeration

NPPES CertifiedJuly 18, 2023

✔ NPI 1205450400 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in NC · 0010-10234

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Also ListedPhysician Assistant · MedicalTaxonomy 363AM0700X

1126 N CHURCH ST, Greensboro, NC 27401

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Oscar Health Plan of North Carolina, Inc.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Wylder Shepherd Fondaw Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Emergency department visit with high level of medical decision making 99285

An emergency department visit for severe conditions is when you urgently seek medical help due to serious health issues. These could be severe injuries, breathing problems, unbearable pain, or sudden severe illness. Doctors and nurses will provide immediate care to stabilize your condition.

20 services20 patients

Critical care, first 30-74 minutes 99291

Critical care involves immediate and constant attention by a team of specially-trained health professionals. It's for patients with life-threatening conditions, requiring first 30-74 minutes of intense monitoring and treatment.

11 services11 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 27401 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$83.90 typical visit price

range $54.12 – $165.09

Typical copayment $20.97 (range $13.53 – $41.27)

Most-billed visit code 99203

Established Patient

$67.72 typical visit price

range $17.21 – $134.61

Typical copayment $16.93 (range $4.30 – $33.65)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

75/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored as part of a group practice

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. KAREN LOUISE ECHERD CORNELIUSSEN M.S., C.G.C.

Genetic Counselor, MS

1126 N CHURCH ST, SUITE 203
GREENSBORO, NC 27401

Guilford County (336) 235-0944

JILL MCDANIEL NURSE PRACTITIONER

Nurse Practitioner (Gerontology)

1126 N CHURCH ST
GREENSBORO, NC 27401

Guilford County (336) 938-0800

MOSES CONE AFFILIATED PHYSICIANS

Internal Medicine (Cardiovascular Disease)

1126 N CHURCH ST, SUITE 300
GREENSBORO, NC 27401

Guilford County (336) 547-1752

DR. EDMUND JOSEPH LEBAUER M.D.

Internal Medicine

1126 N CHURCH ST, SUITE 300
GREENSBORO, NC 27401

Guilford County (336) 547-1700

DR. MARY HERRING PARKER PHARMD

Pharmacist (Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist)

1126 N CHURCH ST, SUITE 300
GREENSBORO, NC 27401

Guilford County (336) 547-1752

CHRISTOPHER P. FENDER, MD, PLLC

Plastic Surgery

1126 N CHURCH ST, SUITE 101
GREENSBORO, NC 27401

Guilford County (336) 275-0919

JOHN P. GOODMAN D.D.S.

Dentist (General Practice)

1126 N CHURCH ST, SUITE 102
GREENSBORO, NC 27401

Guilford County (336) 370-4040

RHONDA G. BARRETT PA-C

Physician Assistant

1126 N CHURCH ST, STE 300
GREENSBORO, NC 27401

Guilford County (336) 547-1700

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Wylder Fondaw's NPI number?

The NPI number for Wylder Fondaw is 1205450400. It was assigned to this individual provider in the NPPES registry on June 3, 2020.

Where is Wylder Fondaw located?

Wylder Fondaw practices at 1126 N Church St, Greensboro, NC 27401. The listed phone number is (336) 832-7000.

What is Wylder Fondaw's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Wylder Fondaw enrolled in Medicare?

Yes. Wylder Fondaw is registered in the Medicare PECOS enrollment system.

What insurance does Wylder Fondaw accept?

Health plans from Oscar Health Plan of North Carolina, Inc list Wylder Fondaw as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Wylder Fondaw was last updated on July 18, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.