Active NPI
Steven Karl Wilson, MD
- Urology Physician
- Indio, CA
National Provider Identifier
1043211675
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- C51286
- Practice address
- 81719 Dr Carreon Blvd
Pod C
Indio, CA 92201-5518 - Phone
- (760) 342-6657
- Fax
- (760) 342-6658
- NPI assigned
- Aug 4, 2005
- 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 |
|---|---|---|---|---|
| Urology Physician | 208800000X | C51286 | CA | Primary |
Addresses
Primary practice location
81719 Dr Carreon Blvd
Pod C
Indio, CA 92201-5518
Mailing address
2051 SE 3Rd St
Unit 401
Deerfield Beach, FL 33441-5197
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00C512861 | Other | CA | PPIN |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C51286 | CA | MD | Urology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Institute for Urologic Excellence | Urology | Past | Accepting new patients |
Networks
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H1722
Organizations & group practices 1
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.
-
- Urology Physician
- Indio, CA
- NPI 1386644904
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123113600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1043211675",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2051 SE 3RD ST",
"address_2": "UNIT 401",
"city": "DEERFIELD BEACH",
"state": "FL",
"postal_code": "334415197"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "81719 DR CARREON BLVD",
"address_2": "POD C",
"city": "INDIO",
"state": "CA",
"postal_code": "922015518",
"telephone_number": "760-342-6657",
"fax_number": "760-342-6658"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "STEVEN",
"middle_name": "KARL",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "CA",
"license": "C51286",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PPIN",
"identifier": "00C512861",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indio, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.