Kevin David Wilson

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT010461 Issued in OH

Practice address

2835 Miami Village Dr
Miamisburg, OH 45342-4587

Phone

(937) 449-0796

Fax

(937) 262-7468

NPI assigned

Feb 15, 2006

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

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Beacon Orthopaedics and Sports Medicine LTDGroup PAC ID 0345136412, 471 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kevin.wilsonpt.p1@direct.beaconortho.nextgenshare.com

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.

• Beacon Orthopaedics & Sports Medicine, LTD

  • Specialist
  • Cincinnati, OH
  • NPI 1386670065

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Beacon Orthopaedics & Sports Medicine LTD

  • Orthopaedic Foot and Ankle Surgery Physician
  • Worthington, OH
  • NPI 1699472878
  NPD
• Orthopaedic Consultants of Cincinnati, Inc.

  • Orthopaedic Surgery Physician
  • Cincinnati, OH
  • NPI 1396792529
  NPD (past)

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

{
    "created_epoch": "1139961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568073600000",
    "number": "1104890128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6480 HARRISON AVE STE 201",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452477961",
            "telephone_number": "513-354-3700",
            "fax_number": "513-354-7651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2835 MIAMI VILLAGE DR",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453424587",
            "telephone_number": "937-449-0796",
            "fax_number": "937-262-7468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KEVIN",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-15",
        "last_updated": "2019-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OH",
            "license": "PT010461",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHCS",
            "identifier": "9416961",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2638622",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00421513",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000385602",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alcue Williams
• Charles Richard Williams Jr.
• Jennifier Marie Williams, CDCA
• Joan P Williams, PH.D.
• Tyler Williford
• Wing Eyecare, Inc.
• Rachel Ann Winn, MA, CCC-SLP
• Charlene Marie Winslow
• Gregory R Wise, MD
• Phillip Witcher, MD

• Physical Therapist in Miamisburg, OH
• Providers in Miamisburg, OH by specialty
• Physical Therapist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2019; 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.