Active NPI
Shane Wilson
- Case Manager/Care Coordinator
- Pickerington, OH
National Provider Identifier
1053129007
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 10400 Blacklick Eastern Rd
Pickerington, OH 43147-8235 - Phone
- (614) 729-6900
- NPI assigned
- Dec 23, 2024
- 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 |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | OH | Primary |
Addresses
Primary practice location
10400 Blacklick Eastern Rd
Pickerington, OH 43147-8235
Mailing address
1098 Cambridge Rd
Coshocton, OH 43812-2703
Phone (740) 552-0375
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0487170 | Medicaid | OH |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1734912000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1734912000000",
"number": "1053129007",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1098 CAMBRIDGE RD",
"city": "COSHOCTON",
"state": "OH",
"postal_code": "438122703",
"telephone_number": "740-552-0375"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10400 BLACKLICK EASTERN RD",
"city": "PICKERINGTON",
"state": "OH",
"postal_code": "431478235",
"telephone_number": "614-729-6900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "SHANE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-12-23",
"last_updated": "2024-12-23",
"certification_date": "2024-12-23",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "OH",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0487170",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pickerington, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.