Mr Jeb Riley Wild, DPT in Gresham, OR - Medicare Physical Therapist Provider

Mr Jeb Riley Wild, DPT is a medicare enrolled "Physical Therapist" provider in Gresham, Oregon. His current practice location is 24076 Se Stark St Ste 200, Gresham, Oregon. You can reach out to his office (for appointments etc.) via phone at (503) 491-1666.

Mr Jeb Riley Wild is licensed to practice in Oregon (license number 65159) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1497526222.

Contact Information

	Mr Jeb Riley Wild, DPT
	24076 Se Stark St Ste 200, Gresham, OR 97030-3376
	(503) 491-1666
	Not Available

Map and Direction

Healthcare Provider's Profile

Full Name	Mr Jeb Riley Wild
Gender	Male
Speciality	Physical Therapist
Location	24076 Se Stark St Ste 200, Gresham, Oregon
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1497526222
Provider Enumeration Date: 01/10/2024
Last Update Date: 01/10/2024

Medicare PECOS Information:

PECOS PAC ID: 8022450980
Enrollment ID: I20240523000332

Medical Identifiers

Medical identifiers for Mr Jeb Riley Wild such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1497526222	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
225100000X	Physical Therapist	65159 (Oregon)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mr Jeb Riley Wild allows following entities to bill medicare on his behalf.

Provider Name	Gateway Parkrose Sports Care Pt Llc
Provider Type	Part B Supplier - Clinic/group Practice
Provider Identifiers	NPI Number: 1982748141 PECOS PAC ID: 7113078973 Enrollment ID: O20090708000133

Provider Name	Sportscare Physical Therapy @ Cornell, Llc
Provider Type	Part B Supplier - Clinic/group Practice
Provider Identifiers	NPI Number: 1649534793 PECOS PAC ID: 7517115579 Enrollment ID: O20120917000315

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Jeb Riley Wild is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Mr Jeb Riley Wild, DPT 140 Sw Columbia St Apt 1502, Portland, OR 97201-5887 Ph: (772) 971-1144	Mr Jeb Riley Wild, DPT 24076 Se Stark St Ste 200, Gresham, OR 97030-3376 Ph: (503) 491-1666

Reviews and Comments

Physical Therapist in Gresham, OR

Namita Avarsekar, Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 304 Ne Hood Ave, Gresham, OR 97030 Phone: 503-666-1333 Fax: 503-666-2444
Paul Song Eo, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 24076 Se Stark St Ste 200, Gresham, OR 97030 Phone: 503-491-1666
Rylee Pittullo, Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 25500 Se Stark St Ste 103, Gresham, OR 97030 Phone: 503-328-0222 Fax: 503-328-0223
Mr. Clem George Eischen Jr., PT Physical Therapist Medicare: Medicare Enrolled Practice Location: 24076 Se Stark St, Gresham, OR 97030 Phone: 503-491-1666
Lindsey Soule, PT, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 304 Ne Hood Ave Ste 100, Gresham, OR 97030 Phone: 503-666-1333
Kaeli Frank, Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 7927 Se Orient Dr, Gresham, OR 97080 Phone: 503-663-0481
Stacia Akers, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 24800 Se Stark St, Gresham, OR 97030 Phone: 503-413-3879 Fax: 503-413-4379

Mr Jeb Riley Wild, DPT - Medicare Physical Therapist in Gresham, OR