Amy M Wilson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

50.002742 Issued in OH

Practice address

319 W Lorain St
Oberlin, OH 44074-1027

Phone

(440) 775-1881

Fax

(440) 774-5707

NPI assigned

Mar 31, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

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 and National Provider Directory roles.

• Emergency Professional Services, Inc.

  dba Emergency Professional Services of Ohio, Inc.

  • Emergency Medicine Physician
  • Seaman, OH
  • NPI 1093762353
  Medicare reassignment
• David R. Mandel MD Inc.

  • Rheumatology Physician
  • Cleveland, OH
  • NPI 1508050915
  NPD (past)

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

{
    "created_epoch": "1206921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1286150400000",
    "number": "1063684090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 636461",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452636461",
            "telephone_number": "440-988-1009",
            "fax_number": "440-988-1225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 W LORAIN ST",
            "city": "OBERLIN",
            "state": "OH",
            "postal_code": "440741027",
            "telephone_number": "440-775-1881",
            "fax_number": "440-774-5707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "AMY",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-31",
        "last_updated": "2010-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.002742",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0236248",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Timothy Mark Weekley
• Wessell Generations, Inc. (Welcome Nursing Home)
• Whole Approach Equine Therapies, LLC
• Whole Woman Holistic Gynecology, LLC
• Alicia Marie Williams
• Ashly Marie Yakunovich

• Physician Assistant in Oberlin, OH
• Providers in Oberlin, OH by specialty
• Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.