Active NPI
Jeremy T Wilson, DMD
- Dentist
- North Las Vegas, NV
National Provider Identifier
1023186095
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 5090
- Practice address
- 2301 E Lake Mead Blvd
North Las Vegas, NV 89030-7137 - Phone
- (702) 331-8338
- Fax
- (702) 639-0579
- NPI assigned
- Nov 30, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 5090 | NV | Primary |
Addresses
Primary practice location
2301 E Lake Mead Blvd
North Las Vegas, NV 89030-7137
Mailing address
526 S Tonopah Dr
Ste. 200
Las Vegas, NV 89106-4043
Phone (702) 291-2031
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023186095 | Medicaid | NV | |
| 100510344 | Medicaid | NV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160927003194 | NV | Order and Referring Only - Other (Non-Physician) | 8921395435 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1465948800000",
"number": "1023186095",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "526 S TONOPAH DR",
"address_2": "STE. 200",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891064043",
"telephone_number": "702-291-2031",
"fax_number": "702-366-1483"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2301 E LAKE MEAD BLVD",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "890307137",
"telephone_number": "702-331-8338",
"fax_number": "702-639-0579"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JEREMY",
"middle_name": "T",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-30",
"last_updated": "2016-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NV",
"license": "5090",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1023186095",
"state": "NV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100510344",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in North Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.