Individual provider Active NPI

Jonathan Wilford, DO

  • Family Medicine Physician
  • Quincy, IL
National Provider Identifier
1013203314
Registry record updated Dec 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036134782 Issued in IL
Practice address
927 Broadway St
Suite 121
Quincy, IL 62301-2719
Phone
(217) 224-6423
Fax
(217) 277-5960
NPI assigned
Jun 24, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X O-1414 ID
Family Medicine Physician 207Q00000X 036134782 IL Primary

Addresses

Primary practice location

927 Broadway St
Suite 121
Quincy, IL 62301-2719

Mailing address

927 Broadway St
Quincy, IL 62301-2719
Phone (217) 224-6423

Other identifiers 1

IdentifierTypeStateIssuer
036134782MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200929001916 ID Practitioner - Family Practice 6800035742 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Touro Un College of Osteopathic Medicine, Vallejo, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountain View Hospital LLCGroup PAC ID 4486562774, 272 clinicians

Practice addresses (Care Compare)

2305 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 522-1764

2325 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 557-2700

2330 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 552-1234

2351 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 522-7310

2353 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 552-4823

2375 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 552-1234

2725 Channing Way
Idaho Falls, ID 83404-7510
Phone (208) 525-8448

Hospital & facility affiliations

  • Aspen Home Health Services Home health agency, Idaho Falls, ID, CCN 137081
  • Mountain View Hospital Hospital, Idaho Falls, ID, CCN 130065
  • Idaho Falls Community Hospital, LLC Hospital, Idaho Falls, ID, CCN 130074
  • Eastern Idaho Regional Medical Center Hospital, Idaho Falls, ID, CCN 130018

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
O-1414IDMDFamily Medicine Physician
036134782ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Care Family Medicine Current Accepting new patients
Teton Valley Health Care Inc Family Medicine CurrentSince Jan 12, 2023 Accepting new patients
Mountain View Hospital LLC CurrentSince Aug 6, 2023 Accepting new patients
Community Care West Side LLC Family Medicine CurrentSince Aug 6, 2023 Accepting new patients
Teton Valley Health Care Inc Family Medicine Current Accepting new patients
Teton Valley Health Care, Inc CurrentSince Jan 12, 2023 Accepting new patients
Mountain View Hospital Physician Organization Past Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

283 N 1st St
Driggs, ID 83422
Phone (208) 354-2302

120 E Howard St
Driggs, ID 83422
Phone (208) 354-2302

2730 Channing Way
Idaho Falls, ID 83404
Phone (208) 542-7100

2725 Channing Way
Idaho Falls, ID 83404
Phone (208) 525-8448

2325 Coronado St
Idaho Falls, ID 83404
Phone (208) 528-7686

765 S Utah Ave
Idaho Falls, ID 83402
Phone (208) 525-2600

404 N 2nd E
Rexburg, ID 83440
Phone (208) 359-1770

167 E 1st S
Rigby, ID 83442
Phone (208) 745-8747

Organizations & group practices 8

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1308873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672272000000",
    "number": "1013203314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "927 BROADWAY ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623012719",
            "telephone_number": "217-224-6423",
            "fax_number": "217-228-3251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "927 BROADWAY ST",
            "address_2": "SUITE 121",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623012719",
            "telephone_number": "217-224-6423",
            "fax_number": "217-277-5960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILFORD",
        "first_name": "JONATHAN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-24",
        "last_updated": "2022-12-29",
        "certification_date": "2022-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "O-1414",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036134782",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036134782",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Quincy, IL

Sources for this page

Verify at the official NPI Registry.