NPIMap

Individual provider Active NPI

Bruce Wilson

  • Physician Assistant
  • Whiteville, NC
National Provider Identifier
1093767667
Registry record updated Feb 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-03556 Issued in NC
Practice address
320 Jefferson St
Whiteville, NC 28472-3602
Phone
(910) 641-8600
NPI assigned
May 16, 2006
Last updated
Feb 12, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-03556 NC Primary

Addresses

Primary practice location

320 Jefferson St
Whiteville, NC 28472-3602

Mailing address

320 Jefferson St
Whiteville, NC 28472-3602

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, SC2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120914000233 NC Practitioner - Physician Assistant 3375646763 Reassigns benefits to 3 organizations
I20130219000500 SC Practitioner - Physician Assistant 3375646763 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

500 Jefferson St
Whiteville, NC 28472-3634
Phone (910) 642-8011

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1628SCMDHematology & Oncology Physician
0010-03556NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Columbus Regional Health Network CurrentSince Jun 11, 2018 Accepting new patients
Access Medical Management, Inc CurrentSince Jun 24, 2017 Accepting new patients
Columbus Regional Healthcare System CurrentSince Sep 16, 2019 Accepting new patients
Columbus Regional Health Network CurrentSince Jun 11, 2018 Accepting new patients
Holly Ridge Chiropractic & Auto Injury PastSince Aug 1, 2015 Accepting new patients
Nason Medical Center V, LLC Past Accepting new patients
Battle Creek Emergency Physicians, PC Physician Assistant Past Accepting new patients
Columbus Regional Health Network Past Accepting new patients
Nason Medical Center IV, LLC Past Accepting new patients
Urvish K Shah, MD PC Past Accepting new patients
Calhoun County Emergency Physicians PC Past Accepting new patients

Locations

320 Jefferson St
Whiteville, NC 28472
Phone (910) 641-8600

500 Jefferson St
Whiteville, NC 28472
Phone (910) 642-1776

612 Jefferson St
#28
Whiteville, NC 28472
Phone (910) 640-4064

619 Jefferson St
Whiteville, NC 28472
Phone (910) 642-0331

3816 Highway 17 S
North Myrtle Beach, SC 29582
Phone (843) 272-1411

Interoperability endpoints

  • Direct secure messaging: bwilson01@crhn.cernerdirect.com

Organizations & group practices 15

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.

View all 15

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": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549929600000",
    "number": "1093767667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 JEFFERSON ST",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "284723602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 JEFFERSON ST",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "284723602",
            "telephone_number": "910-641-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "BRUCE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2019-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-03556",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Whiteville, NC

Sources for this page

Verify at the official NPI Registry.