Charles Wilson, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

MD09689 Issued in OR

Practice address

665 Winter St SE
Salem, OR 97301-3919

Phone

(503) 561-5634

NPI assigned

Sep 5, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 9

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

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.

• Salem Emergency Physicians Service, PC

  • Emergency Medicine Physician
  • Salem, OR
  • NPI 1063454395
  NPD (past)

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

{
    "created_epoch": "1157414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198022400000",
    "number": "1033211339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2505",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973082505",
            "telephone_number": "888-828-3198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "665 WINTER ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973013919",
            "telephone_number": "503-561-5634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-05",
        "last_updated": "2007-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OR",
            "license": "MD09689",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MARION POLK CHP",
            "identifier": "116012",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "A020",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "XPY049920",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8302143",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDENCE",
            "identifier": "A44718",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PACIFIC SOURCE",
            "identifier": "M400711",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "116012",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PACC",
            "identifier": "FM1W751",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH",
            "identifier": "A44718",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Betty L Willis, MA, LPC
• David G Willis, DMD
• Willson House
• Adrienne Erin Wilson, CLD, CPD, CCE, NCS
• Benjamin R Wilson, MD
• Christine Wilson, P.A.-C.
• Colleen Joy Wilson, FNP-C
• Halle L. Wilson, DPT, OCS
• Jennifer Wilson
• Kathleen Marie Wilson

• Emergency Medicine Physician in Salem, OR
• Providers in Salem, OR by specialty
• Emergency Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.