NPIMap

Individual provider Active NPI

John Marshall Wilson, MD

  • Anesthesiology Physician
  • Louisville, KY
National Provider Identifier
1114227139
Registry record updated Aug 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
47643 Issued in KY
Practice address
1850 Bluegrass Ave
Louisville, KY 40215
Phone
(502) 361-6617
Fax
(502) 361-6637
NPI assigned
Oct 25, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X TP926 KY
Anesthesiology Physician 207L00000X 47643 KY Primary

Addresses

Primary practice location

1850 Bluegrass Ave
Louisville, KY 40215

Mailing address

100 E Liberty St Ste 800
Louisville, KY 40202-1428
Phone (502) 361-6617

Other practice location 1

320 Whittington Pkwy
Suite 301
Louisville, KY 40222-4928
Phone (502) 625-5584

Other identifiers 2

IdentifierTypeStateIssuer
7100323720MedicaidKY
K153505OtherKYMEDICARE PIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, IN2 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
I20140902000427 KY Practitioner - Anesthesiology 5890913016 Reassigns benefits to 1 organization
I20180924003231 IN Practitioner - Anesthesiology 5890913016

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Texas Medical School at San Antonio, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St. Claire Medical Center IncGroup PAC ID 4486559085, 181 clinicians

Practice addresses (Care Compare)

222 Medical Cir
Morehead, KY 40351-1179
Phone (606) 783-6500

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
47643KYMDAnesthesiology Physician
TP926KYMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Apollo Medical Group LLC Anesthesiology CurrentSince Aug 11, 2018 Accepting new patients
St Claire Medical Center, Inc., Anesthesiology Current Accepting new patients
St Claire Medical Center Inc. CurrentSince Jul 1, 2025 Accepting new patients
St Claire Medical Center, Inc CurrentSince Jul 1, 2025 Accepting new patients
Komg-Louisville Region Inc. Anesthesiology Past Accepting new patients
U S Anesthesia Partners of Kentucky PSC Anesthesiology PastSince Jul 1, 2023 Accepting new patients

Locations

1276 N Plaza Dr
Rockport, IN 47635
Phone (812) 649-2500

222 Medical Cir
Morehead, KY 40351
Phone (606) 783-6455

Organizations & group practices 6

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.

Hospital & facility affiliations 3

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": "1287964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567036800000",
    "number": "1114227139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E LIBERTY ST STE 800",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021428",
            "telephone_number": "502-361-6617",
            "fax_number": "502-361-6637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 BLUEGRASS AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40215",
            "telephone_number": "502-361-6617",
            "fax_number": "502-361-6637"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "320 Whittington Pkwy",
            "address_2": "Suite 301",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402224928",
            "country_code": "US",
            "telephone_number": "502-625-5584",
            "fax_number": "502-426-2264",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JOHN",
        "middle_name": "MARSHALL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-10-25",
        "last_updated": "2019-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "KY",
            "license": "TP926",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "KY",
            "license": "47643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100323720",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "K153505",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.