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DR. RASHIDAH TYNETTA WILEY D.D.S.
NPI 1578829974
Dentist - Oral and Maxillofacial Pathology in Elk Grove, CA

Active since April 10, 2012PECOS Enrolled
2400 MARITIME DR, ELK GROVE, CA 95758(916) 686-8914 Get Directions Write a Review

NPPES record last updated: January 16, 2024. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: May 16, 2019, Oct 13, 2018, Jul 12, 2018 (3 updates tracked since 2018).

About Dr. Rashidah Tynetta Wiley D.d.s. NPPES

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

DR. RASHIDAH TYNETTA WILEY D.D.S. (NPI 1578829974) is an individual oral and maxillofacial pathology provider in Elk Grove, California, licensed in California (64355) and active in the NPI registry since April 2012. She is enrolled in Medicare PECOS and maintains a secondary practice location in Portland.

NPPES Registry Identity

NPI1578829974
Entity TypeIndividualFemale
Primary Taxonomy1223P0106X
Provider Legal NameDR. RASHIDAH TYNETTA WILEYCredential: D.D.S.
Location Address2400 MARITIME DRElk Grove, CA 95758-3660
Mailing Address9700 W Taron DrElk Grove, CA 95757-8145 · (916) 378-1007
Phone(916) 686-8914
Sole ProprietorNo
Enumeration DateApril 10, 2012
Last NPPES UpdateJanuary 16, 20243 updates tracked since enumeration
NPPES CertifiedJanuary 16, 2024
✔ NPI 1578829974 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial PathologyDental Providers
Taxonomy Code1223P0106X
Licenses✔ Licensed in CA · 64355✔ Licensed in ME · DEN4597✔ Licensed in KY · 10225
Definition
The specialty of dentistry and discipline of pathology that deals with the nature, identification, and management of diseases affecting the oral and maxillofacial regions. It is a science that investigates the causes, processes, and effects of these diseases. The practice of oral and maxillofacial pathology includes research and diagnosis of diseases using clinical, radiographic, microscopic, biochemical, or other examinations.
2400 MARITIME DR, Elk Grove, CA 95758
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Secondary Practice Location 1

Location 1716 Stevens AvePortland, ME 04103 · Phone (207) 221-4876

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Rashidah Tynetta Wiley D.d.s. 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.

Medicare Billing Reassignment

Medicare enrollment records show Rashidah Wiley reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Lucent Pathology Partners, Inc
20 mi
Anatomic Pathology & Clinical Pathology
6501 COYLE AVE
Carmichael, CA 95608
  • Reassigned Medicare billing, California enrollment
  • 13 clinicians in this Medicare group
NPI 1124098736 (916) 537-5275

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95758 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
$92.61 typical visit price
range $60.44 – $180.85
Typical copayment $23.15 (range $15.11 – $45.21)
Most-billed visit code 99203
Established Patient
$75.03 typical visit price
range $19.88 – $148.15
Typical copayment $18.75 (range $4.97 – $37.03)
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.

Other Providers at the Same Location NPPES

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

DR. LESA RAE WOODSON DDS
Dentist
2400 MARITIME DR
ELK GROVE, CA 95758
Sacramento County (916) 686-8914

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 Rashidah Wiley's NPI number?

The NPI number for Rashidah Wiley is 1578829974. It was assigned to this individual provider in the NPPES registry on April 10, 2012.

Where is Rashidah Wiley located?

Rashidah Wiley practices at 2400 Maritime Dr, Elk Grove, CA 95758. The listed phone number is (916) 686-8914.

What is Rashidah Wiley's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Pathology, with taxonomy code 1223P0106X.

Is Rashidah Wiley enrolled in Medicare?

Yes. Rashidah Wiley is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Rashidah Wiley's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Rashidah Wiley reassigns Medicare benefits to Lucent Pathology Partners, Inc (Carmichael, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Rashidah Wiley's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Rashidah Wiley was last updated on January 16, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.