Active NPI
Timothy William Wilkins, M.A., M.D.
- Family Medicine Physician
- Fall River Mills, CA
National Provider Identifier
1114106853
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(2) exclusion effective Jun 20, 2017.
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- A102151
- Practice address
- 43563 State Highway 299 E
Fall River Mills, CA 96028-9787 - Phone
- (530) 336-6535
- Fax
- (530) 335-5166
- NPI assigned
- Oct 30, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | A102151 | CA | Primary |
| Emergency Medicine Physician | 207P00000X | A102151 | CA |
Addresses
Primary practice location
43563 State Highway 299 E
Fall River Mills, CA 96028-9787
Mailing address
3635 Sunglow Dr
Redding, CA 96001-6144
Phone (847) 275-5718
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A102151 | Other | CA | BLUE SHIELD |
| DC206Z | Other | CA | MEDICARE PTAN |
| 00A102151 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Master of Arts, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A102151 | CA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193702400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321833600000",
"number": "1114106853",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3635 SUNGLOW DR",
"city": "REDDING",
"state": "CA",
"postal_code": "960016144",
"telephone_number": "847-275-5718"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "43563 STATE HIGHWAY 299 E",
"city": "FALL RIVER MILLS",
"state": "CA",
"postal_code": "960289787",
"telephone_number": "530-336-6535",
"fax_number": "530-335-5166"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILKINS",
"first_name": "TIMOTHY",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "M.A., M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-10-30",
"last_updated": "2011-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "A102151",
"primary": true
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "CA",
"license": "A102151",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "00A102151",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "DC206Z",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A102151",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fall River Mills, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.