SAMANTHA WILDER MD
NPI 1780383463
Student in an Organized Health Care Education/Training Program in Detroit, MI

Active since March 01, 2023PECOS Enrolled
2799 W GRAND BLVD, DETROIT, MI 48202(313) 916-2600 Get Directions Write a Review

NPPES record last updated: March 23, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Mar 23, 2023, Mar 1, 2023 (2 updates tracked since 2023).

About Samantha Wilder Md NPPES

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

SAMANTHA WILDER MD (NPI 1780383463) is an individual student in an organized health care education/training program in Detroit, Michigan and active in the NPI registry since March 2023. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1780383463
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameSAMANTHA WILDERCredential: MD
Location Address2799 W GRAND BLVDDetroit, MI 48202-2608
Mailing Address2799 W Grand BlvdDetroit, MI 48202-2608 · (313) 916-2600
Sole ProprietorYes
Enumeration DateMarch 1, 2023
Last NPPES UpdateMarch 23, 20232 updates tracked since enumeration
NPPES CertifiedMarch 23, 2023
NPI 1780383463 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
2799 W GRAND BLVD, Detroit, MI 48202

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

Enrolled in Medicare (PECOS)

Samantha Wilder Md 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.

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.

General Acute Care Hospital
2799 W GRAND BLVD
DETROIT, MI 48202
Radiology (Diagnostic Radiology)
2799 W GRAND BLVD
DETROIT, MI 48202
Radiology (Diagnostic Radiology)
2799 W GRAND BLVD
DETROIT, MI 48202
Family Medicine
2799 W GRAND BLVD
DETROIT, MI 48202
Internal Medicine (Pulmonary Disease)
2799 W GRAND BLVD
DETROIT, MI 48202
Internal Medicine (Cardiovascular Disease)
2799 W GRAND BLVD
DETROIT, MI 48202
Nurse Anesthetist, Certified Registered
2799 W GRAND BLVD
DETROIT, MI 48202
Internal Medicine (Pulmonary Disease)
2799 W GRAND BLVD
DETROIT, MI 48202

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 Samantha Wilder's NPI number?

The NPI number for Samantha Wilder is 1780383463. It was assigned to this individual provider in the NPPES registry on March 1, 2023.

Where is Samantha Wilder located?

Samantha Wilder practices at 2799 W Grand Blvd, Detroit, MI 48202. The listed phone number is (313) 916-2600.

What is Samantha Wilder's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Samantha Wilder enrolled in Medicare?

Yes. Samantha Wilder is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Samantha Wilder was last updated on March 23, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.