DR. SHANE L WILDER MD
NPI 1922667443
Internal Medicine in West Hollywood, CA

Q: What is Shane Wilder's NPI number?

The NPI number for Shane Wilder is 1922667443. It was assigned to this individual provider in the NPPES registry on June 8, 2019.

Q: What is Shane Wilder's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Q: When was this NPI record last updated?

The NPPES record for Shane Wilder was last updated on October 30, 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.

Active since June 08, 2019PECOS EnrolledAccepts Medicare Assignment

8700 BEVERLY BLVD STE 5512, WEST HOLLYWOOD, CA 90048(310) 423-2811 Get Directions Write a Review

NPPES record last updated: October 30, 2024. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Jul 24, 2023, Nov 15, 2022, Sep 15, 2022 and 1 more (4 updates tracked since 2019).

On this page

About Dr. Shane L Wilder Md NPPES

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

DR. SHANE L WILDER MD (NPI 1922667443) is an individual internal medicine provider in West Hollywood, California, licensed in New Mexico (MD2022-0910) and active in the NPI registry since June 2019. He is enrolled in Medicare PECOS, is affiliated with Unm Hospital, and is a graduate of Other (2019).

NPPES Registry Identity

NPI1922667443

Entity TypeIndividualMale

Primary Taxonomy207R00000X

Provider Legal NameDR. SHANE L WILDERCredential: MD

Location Address8700 BEVERLY BLVD STE 5512West Hollywood, CA 90048-1804

Mailing Address800 Bradbury Dr Se Ste 116Albuquerque, NM 87106-4310 · (505) 272-1476

Phone(310) 423-2811

Sole ProprietorYes

Medical School CMSOtherGraduated 2019

Enumeration DateJune 8, 2019

Last NPPES UpdateOctober 30, 20244 updates tracked since enumeration

NPPES CertifiedOctober 30, 2024

✔ NPI 1922667443 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207R00000X

License✔ Licensed in NM · MD2022-0910

Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

8700 BEVERLY BLVD STE 5512, West Hollywood, CA 90048

Open in Google Maps ↗

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Shane L Wilder Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8628448909

PECOS Enrollment IDI20230102000066

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 Shane Wilder reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Unm Medical Group Inc

674 mi

Multi-Specialty

2211 LOMAS NE
Albuquerque, NM 87106

Reassigned Medicare billing, New Mexico enrollment
2,105 clinicians in this Medicare group

NPI 1831218627 (505) 272-3303

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

Areas of Expertise CMS Part B claims 3

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.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

245 services118 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

106 services87 patients

Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215

This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.

39 services31 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Unm Hospital

Acute Care Hospitals · Albuquerque, NM

2/5 CMS rating

OwnershipGovernment - State

CMS Certification Number320001

Location2211 Lomas Boulevard NEAlbuquerque, NM 87106 · Bernalillo County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 90048 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

$142.39 typical visit price

range $62.96 – $187.60

Typical copayment $35.59 (range $15.74 – $46.90)

Most-billed visit code 99204

Established Patient

$109.96 typical visit price

range $20.84 – $153.61

Typical copayment $27.49 (range $5.21 – $38.40)

Most-billed visit code 99214

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 20

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

MATTHEW HERMOSURA BAUTISTA

Student in an Organized Health Care Education/Training Program