Individual provider Active NPI

Michael Wilson, MD

  • Emergency Medicine Physician
  • Boston, MA
National Provider Identifier
1073567319
Registry record updated Jul 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD20836 Issued in ME
Practice address
75 Francis St
Boston, MA 02115-6110
Phone
(617) 732-5640
NPI assigned
May 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 200001030 NC
Emergency Medicine Physician 207P00000X MD20836 ME Primary

Addresses

Primary practice location

75 Francis St
Boston, MA 02115-6110

Mailing address

75 Francis St
Boston, MA 02115-6110
Phone (617) 732-5640

Other identifiers 2

IdentifierTypeStateIssuer
1268UOtherNCBLUE CROSS
891268UMedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, ME2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20080407000215 MA Practitioner - Emergency Medicine 2961492525 Reassigns benefits to 2 organizations
I20240809000197 ME Practitioner - Emergency Medicine 2961492525 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Newburyport Emergency Physicians, PLLCGroup PAC ID 4688193071, 55 clinicians

Practice addresses (Care Compare)

25 Highland Ave
Newburyport, MA 01950-3867
Phone (978) 463-1000

75 Francis St
Boston, MA 02115-6110
Phone (617) 732-5500

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD20836MEMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Brigham and Women'S Hospital Current Accepting new patients
Newburyport Emergency Physicians, PLLC Emergency Medicine CurrentSince Oct 1, 2025 Accepting new patients
Emergency Medicine Services of Maine, LLC Emergency Medicine CurrentSince Sep 15, 2024 Accepting new patients
Medlantic Healthcare Group Emergency Medicine Past Accepting new patients

Locations

75 Francis St
Boston, MA 02115

25 Highland Ave
Newburyport, MA 01950
Phone (978) 258-4734

897 W Main St
Dovr Foxcroft, ME 04426
Phone (207) 564-4464

50 Union St
Ellsworth, ME 04605
Phone (207) 664-5304

447 N Main St
Pittsfield, ME 04967
Phone (207) 487-0981

307 S Evergreen Ave
Woodbury, NJ 08096
Phone (856) 686-4300

Interoperability endpoints

  • Direct secure messaging: wilson.michael.bwh@direct.partners.masshiway.net

Organizations & group practices 5

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 5

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": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719964800000",
    "number": "1073567319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 FRANCIS ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021156110",
            "telephone_number": "617-732-5640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 FRANCIS ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021156110",
            "telephone_number": "617-732-5640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-20",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "200001030",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "ME",
            "license": "MD20836",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "1268U",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891268U",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.