Illya L Wilkerson, MD
Individual provider Active NPI Internal Medicine Physician · Los Angeles, CA
NPI 1124097183 · NPPES record last updated Nov 29, 2021
Key facts
- NPI
- 1124097183
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 9900388 (NC)
- Practice address
- 4950 W Sunset Blvd
Los Angeles, CA 90027-5822 - Phone
- (323) 783-7582
- NPI assigned
- Mar 14, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Hospitalist
- Education
- University of North Carolina at Chapel Hill School of Medicine, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Southern California Permanente Medical Group
Practice addresses (Care Compare)
4725 -4733 Sunset Blvd
Los Angeles, CA 90027-6021
Phone (323) 783-4011
4733 W Sunset Blvd
Los Angeles, CA 90027-6021
Phone (213) 667-4784
4867 W Sunset Blvd
Los Angeles, CA 90027-5969
Phone (323) 783-4011
Hospital & facility affiliations
- Kaiser Foundation Hospital - Los Angeles
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20081230000273 | CA | Practitioner - Hospitalist |
4486624855 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9900388 | NC | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern California Permanente Medical Group | Current |
Accepting new patients | |
| Southern California Permanente Medical Group | Current | Accepting new patients | |
| Primedoc of Stanly County PA | Internal Medicine | Past | Accepting new patients |
| Primedoc of Randolph County PA | Internal Medicine | Past | Accepting new patients |
Locations
4950 W Sunset Blvd
Los Angeles, CA 90027
Phone (323) 783-2841
6041 Cadillac Ave
Los Angeles, CA 90034
Phone (323) 857-2000
4733 W Sunset Blvd
Los Angeles, CA 90027
Phone (213) 667-4784
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 9900388 | NC | Yes |
Addresses
Primary practice location
4950 W Sunset Blvd
Los Angeles, CA 90027-5822
Mailing address
4950 W Sunset Blvd
Los Angeles, CA 90027-5822
Phone (323) 783-7582
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 89126UM | Medicaid | NC | |
| P00011666 | Other | NC | RAILROAD MEDICARE |
| 126UM | Other | NC | BCBS |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq | Health Information Exchange (HIE) | Southern California Permanente Medical Group |
Other providers in Los Angeles, CA
- Jennifer Howard Wilker
- Moshe Wilker
- Doris Wilkerson
- Ginger L Wilkerson
- Giovanna Wilkerson
- Kelly Cherie Wilkerson
- Michelle Wilkerson
- Shelley Lane Wilkerson
- Wendy Sheron Wilkes-Hendrick
- Carter Christian Wilkes
All providers in Los Angeles, CA · Internal Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 29, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.