Jimmie Joe Wilson, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

110637 Issued in MO

Practice address

2727 MC Clelland Blvd
Joplin, MO 64804-1626

Phone

(417) 625-2190

Fax

(417) 625-2097

NPI assigned

Apr 26, 2007

Last updated

Jul 8, 2007By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in MO, KS2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

University of Kansas School of Med (KC/Wich/Sal), 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• J&L Wilson Enterprises LLC

  • Physical Therapist
  • Joplin, MO
  • NPI 1346966017

  KS

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053531939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25465 LEFFEN LN",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648016366",
            "telephone_number": "417-623-6384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2727 MC CLELLAND BLVD",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648041626",
            "telephone_number": "417-625-2190",
            "fax_number": "417-625-2097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JIMMIE",
        "middle_name": "JOE",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "110637",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Annette Willoughby, L.C.S.W.
• Alicia Wilson
• Brett Michael Wilson, D.D.S.
• Danielle Wilson
• Darrell A Wilson, LPC, CRC
• John Wilson
• Patricia Marie Wilson, RN
• Stephen Wade Wilson
• Jessica B Windschitl, DO
• Jourdan S Winfrey, RDH

• Physical Therapist in Joplin, MO
• Providers in Joplin, MO by specialty
• Physical Therapist in Missouri

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.