NPIMap

Individual provider Active NPI

Jeffrey P Wilson, MD

  • Interventional Cardiology Physician
  • Fenton, MO
National Provider Identifier
1003287079
Registry record updated Jul 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
2025010674 Issued in MO
Practice address
1011 Bowles Ave Ste 300
Fenton, MO 63026-2387
Phone
(636) 496-5065
NPI assigned
Oct 15, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Cardiology Physician 207RI0011X 147427 MT
Cardiovascular Disease Physician 207RC0000X 036165783 IL
Interventional Cardiology Physician 207RI0011X 036165783 IL
Interventional Cardiology Physician 207RI0011X 2025010674 MO Primary
Internal Medicine Physician 207R00000X 036165783 IL
Interventional Cardiology Physician 207RI0011X 10415 SD

Addresses

Primary practice location

1011 Bowles Ave Ste 300
Fenton, MO 63026-2387

Mailing address

345 W Steamboat Dr Ste 601
North Sioux City, SD 57049-5287

Other practice location 1

2300 N Edward St
Decatur, IL 62526-4192
Phone (217) 876-8121

Other practice location 2

619 E Mason St
Springfield, IL 62701-1034
Phone (217) 788-0706

Other practice location 3

1300 28th St S Fl 2
Great Falls, MT 59405-5296
Phone (406) 455-4230

Other practice location 4

201 Anamaria Dr
Rapid City, SD 57701-7305
Phone (605) 503-8192

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD, IL, MO, WY, MT5 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
I20210505002990 SD Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 4981999893 Reassigns benefits to 3 organizations
I20231018000565 IL Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 4981999893 Reassigns benefits to 1 organization
I20250505000472 MO Practitioner - Cardiovascular Disease (Cardiology) 4981999893 Reassigns benefits to 1 organization
I20251002002658 WY Practitioner - Interventional Cardiology 4981999893 Reassigns benefits to 1 organization
I20260505000189 MT Practitioner - Cardiovascular Disease (Cardiology) 4981999893 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional Cardiology
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sage Medical Prof LLCGroup PAC ID 4385992619, 15 clinicians
Vascular and Interventional Radiology of SiouxlandGroup PAC ID 7113330663, 24 clinicians

Practice addresses (Care Compare)

201 Anamaria Dr
Rapid City, SD 57701-7305
Phone (605) 503-8192

201 Anamaria Dr
Rapid City, SD 57701-7376

345 W Steamboat Dr
Dakota Dunes, SD 57049-5287
Phone (605) 217-3345

Hospital & facility affiliations

  • Black Hills Surgical Hospital LLC Hospital, Rapid City, SD, CCN 430091
  • Hans P Peterson Memorial Hospital - Cah Hospital, Philip, SD, CCN 431319
  • Monument Health Rapid City Hospital Hospital, Rapid City, SD, CCN 430077
  • SSM St Clare Health Center Hospital, Fenton, MO, CCN 260081
  • Monument Health Spearfish Hospital Hospital, Spearfish, SD, CCN 430048

Merit-based Incentive Payment System (MIPS)

Final score
77.06 of 100Reported as group
Quality
64.36
Promoting interoperability
81
Improvement activities
40
Cost
75.01

Merit-based Incentive Payment System (MIPS)

Final score
73.88 of 100Reported as group
Quality
63.91
Improvement activities
40
Cost
77.03

Merit-based Incentive Payment System (MIPS)

Final score
80.02 of 100Reported as group
Quality
75.68
Promoting interoperability
78
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting14
Varicose vein removal19
Leg revascularization (restoring blood flow)1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2025010674MOMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Vascular & Interventional Radiology of Siouxland Interventional Cardiology CurrentSince Jan 1, 2025 Accepting new patients
Monument Health Rapid City Hospital, Inc Current Accepting new patients
SSM Medical Group, Inc. Internal Medicine CurrentSince Apr 23, 2025 Accepting new patients
Prairie Cardiovascular Consultants LTD Cardiovascular Disease CurrentSince Mar 1, 2025 Accepting new patients
Decatur Memorial Hospital Internal Medicine CurrentSince Sep 5, 2023 Accepting new patients
Decatur Memorial Hospital CurrentSince Sep 5, 2023 Accepting new patients
Monument Health Rapid City Hospital Inc CurrentSince Apr 16, 2021 Accepting new patients
Sage Medical Prof LLC CurrentSince May 3, 2025 Accepting new patients
SSM Medical Group Inc. CurrentSince Apr 23, 2025 Accepting new patients
SSM Health Care St Louis Cardiovascular Disease CurrentSince May 19, 2025 Accepting new patients
Monument Health Rapid City Hospital, Inc. CurrentSince Apr 16, 2021 Accepting new patients
Black Hills Orthopedic & Spine Center of Wyoming PC Past Accepting new patients
Care United Medical Center of Laramie, LLC Past Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

7344 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-6189

2300 N Edward St
Decatur, IL 62526
Phone (217) 876-3000

241 W Weaver Rd
Ste 145B
Forsyth, IL 62535
Phone (217) 876-5220

619 E Mason St
#4P57
Springfield, IL 62701

619 E Mason St
Springfield, IL 62701
Phone (217) 545-7600

1011 Bowles Ave
Ste 300
Fenton, MO 63026
Phone (636) 496-5000

1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000

1035 Bellevue Ave
Ste 500
Saint Louis, MO 63117
Phone (314) 647-1115

12800 Corporate Hill Dr
Saint Louis, MO 63131
Phone (314) 989-6430

345 W Steamboat Dr
Ste 701
North Sioux City, SD 57049
Phone (319) 430-9340

345 W Steamboat Dr
Ste 601
North Sioux City, SD 57049
Phone (605) 217-5610

353 Fairmont Blvd
Rapid City, SD 57701
Phone (605) 719-1000

201 Anamaria Dr
Rapid City, SD 57701
Phone (605) 217-5611

2201 S Douglas Hwy
Ste 120
Gillette, WY 82718
Phone (307) 370-1574

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CAJECD/Endpoint/CAJECD

Organizations & group practices 15

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 15

Hospital & facility affiliations 22

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 22

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1444867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784160000000",
    "number": "1003287079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 W STEAMBOAT DR STE 601",
            "city": "NORTH SIOUX CITY",
            "state": "SD",
            "postal_code": "570495287",
            "fax_number": "605-217-5533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 BOWLES AVE STE 300",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630262387",
            "telephone_number": "636-496-5065"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2300 N Edward St",
            "address_purpose": "LOCATION",
            "city": "Decatur",
            "state": "IL",
            "postal_code": "625264192",
            "country_code": "US",
            "telephone_number": "217-876-8121",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "619 E Mason St",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "IL",
            "postal_code": "627011034",
            "country_code": "US",
            "telephone_number": "217-788-0706",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1300 28th St S Fl 2",
            "address_purpose": "LOCATION",
            "city": "Great Falls",
            "state": "MT",
            "postal_code": "594055296",
            "country_code": "US",
            "telephone_number": "406-455-4230",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "201 Anamaria Dr",
            "address_purpose": "LOCATION",
            "city": "Rapid City",
            "state": "SD",
            "postal_code": "577017305",
            "country_code": "US",
            "telephone_number": "605-503-8192",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JEFFREY",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-10-15",
        "last_updated": "2026-07-16",
        "certification_date": "2026-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "MT",
            "license": "147427",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036165783",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "IL",
            "license": "036165783",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "MO",
            "license": "2025010674",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036165783",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "SD",
            "license": "10415",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fenton, MO

Sources for this page

Verify at the official NPI Registry.