Individual provider Active NPI

Bryan Wilson, MD

  • Internal Medicine Physician
  • Tacoma, WA
National Provider Identifier
1013332915
Registry record updated Jun 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0101260836 Issued in VA
Practice address
9040 Jackson Ave
Tacoma, WA 98431-2869
Phone
(612) 916-8558
NPI assigned
Feb 28, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 13, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0101260836 VA Primary

Addresses

Primary practice location

9040 Jackson Ave
Tacoma, WA 98431-2869

Mailing address

4708 Bear Creek LN
Gig Harbor, WA 98335-8348

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA, CA3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20210916001969 OR Practitioner - Internal Medicine 3173744265 Reassigns benefits to 1 organization
I20210928003473 WA Practitioner - Internal Medicine 3173744265 Reassigns benefits to 1 organization
I20250113001898 CA Practitioner - Internal Medicine 3173744265 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hospitalist Medicine Physicians of California IncGroup PAC ID 8426062027, 120 clinicians

Practice addresses (Care Compare)

4002 Vista Way
Oceanside, CA 92056-4506
Phone (760) 724-8411

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101260836VAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Sep 27, 2021 Accepting new patients
Kaiser Foundation Health Plan of the Northwest Internal Medicine CurrentSince Sep 27, 2021 Accepting new patients
Hospitalist Medicine Physicians of California, Inc Internal Medicine CurrentSince Jan 1, 2025 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Sep 27, 2021 Accepting new patients

Locations

4002 Vista Way
Oceanside, CA 92056
Phone (760) 724-8411

1100 Las Tablas Rd
Templeton, CA 93465
Phone (805) 434-3500

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

9800 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2457

7201 N Interstate Ave
Portland, OR 97217
Phone (503) 240-4051

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

1230 7th Ave
Longview, WA 98632
Phone (360) 575-4801

7101 NE 137th Ave
Vancouver, WA 98682
Phone (360) 418-6000

Organizations & group practices 4

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 1

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": "1393545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560384000000",
    "number": "1013332915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4708 BEAR CREEK LN",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983358348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9040 JACKSON AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984312869",
            "telephone_number": "612-916-8558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "BRYAN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-02-28",
        "last_updated": "2019-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101260836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.