Individual provider Active NPI

Chase Landon Wilson, M.D.

  • Dermatology Physician
  • Georgetown, KY
National Provider Identifier
1053757641
Registry record updated Jun 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
49577 Issued in KY
Practice address
1158 Lexington Rd
Georgetown, KY 40324-9330
Phone
(502) 316-9425
Fax
(502) 316-9451
NPI assigned
May 22, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 49577 KY Primary

Addresses

Primary practice location

1158 Lexington Rd
Georgetown, KY 40324-9330

Mailing address

PO Box 956
Georgetown, KY 40324-0956
Phone (270) 564-1691

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170516000439 KY Practitioner - Dermatology 5395988273 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of Kentucky College of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Elkhorn Dermatology PLLCGroup PAC ID 1759668148, 3 clinicians

Practice addresses (Care Compare)

304 Boston SQ
Georgetown, KY 40324-9786
Phone (502) 316-9425

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
72.51 of 100Reported as individual
Quality
100
Promoting interoperability
0
Improvement activities
40
Cost
91.71

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision72
Removal of tissue1-10
Removal of skin lesions926
Removal or shaving of skin growth299
Skin biopsy45

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
49577KYMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Elkhorn Dermatology PLLC Dermatology CurrentSince Mar 25, 2017 Accepting new patients

Locations

1158 Lexington Rd
Georgetown, KY 40324
Phone (502) 868-0338

304 Boston Sq
Georgetown, KY 40324
Phone (502) 316-9425

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1369180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750809600000",
    "number": "1053757641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 956",
            "city": "GEORGETOWN",
            "state": "KY",
            "postal_code": "403240956",
            "telephone_number": "270-564-1691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1158 LEXINGTON RD",
            "city": "GEORGETOWN",
            "state": "KY",
            "postal_code": "403249330",
            "telephone_number": "502-316-9425",
            "fax_number": "502-316-9451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "CHASE",
        "middle_name": "LANDON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-22",
        "last_updated": "2025-06-25",
        "certification_date": "2025-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "KY",
            "license": "49577",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, KY

Sources for this page

Verify at the official NPI Registry.