Active NPI
Richard Robert Wilson, M.D.
- General Practice Physician
- Arden Hills, MN
National Provider Identifier
1033358924
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 30699
- Practice address
- 1276 Nursery Hill LN
Arden Hills, MN 55112-5783 - Phone
- (651) 260-8042
- NPI assigned
- Feb 17, 2009
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 30699 | MN | Primary |
Addresses
Primary practice location
1276 Nursery Hill LN
Arden Hills, MN 55112-5783
Mailing address
1276 Nursery Hill LN
Arden Hills, MN 55112-5783
Phone (651) 260-8042
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30699 | MN | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1234828800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1234828800000",
"number": "1033358924",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1276 NURSERY HILL LN",
"city": "ARDEN HILLS",
"state": "MN",
"postal_code": "551125783",
"telephone_number": "651-260-8042"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1276 NURSERY HILL LN",
"city": "ARDEN HILLS",
"state": "MN",
"postal_code": "551125783",
"telephone_number": "651-260-8042"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "RICHARD",
"middle_name": "ROBERT",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-02-17",
"last_updated": "2009-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "MN",
"license": "30699",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Arden Hills, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.