Charles Brady Wilson, PD.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1213 Issued in AZ

Practice address

9316 E Raintree Dr
Ste 130
Scottsdale, AZ 85260-3007

Phone

(480) 778-0202

Fax

(480) 778-0204

NPI assigned

Apr 6, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1978

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Phoenix Eye Group, LLC

  • Ophthalmology Physician
  • Scottsdale, AZ
  • NPI 1982010773
  NPD (past)

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

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466380800000",
    "number": "1003938176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9316 E RAINTREE DR",
            "address_2": "SUITE 130",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852603005",
            "telephone_number": "480-778-0202",
            "fax_number": "480-778-0204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9316 E RAINTREE DR",
            "address_2": "STE 130",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852603007",
            "telephone_number": "480-778-0202",
            "fax_number": "480-778-0204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "CHARLES",
        "middle_name": "BRADY",
        "name_prefix": "Dr.",
        "credential": "PD.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-06",
        "last_updated": "2016-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "AZ",
            "license": "1213",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOL - OWCP",
            "identifier": "188531100",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Philpott Wilmeth, R.PH.
• Andrea Wilson, NP
• Ashley Wilson
• Bridget Wilson, NP
• Carl Wilson, PA-C
• Deborah Dyne Wilson, PHYSICIAN
• Deborah Lynn Wilson, M.D.
• Dorrie Wilson
• Emily Ann Wilson, OTR/L
• Hal B Wilson, M.D.

• Clinical Psychologist in Scottsdale, AZ
• Providers in Scottsdale, AZ by specialty
• Clinical Psychologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.