Kim A Wilson, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

76388 Issued in MA

Practice address

75 Bickford St
Martha Eliot Health Center
Jamaica Plain, MA 02130-1401

Phone

(617) 971-2312

NPI assigned

Nov 24, 2006

Sex

Female

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 1

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Children'S Hospital Pediatric Associates, Inc

  • Pediatrics Physician
  • Boston, MA
  • NPI 1457306664
  Medicare reassignment NPD

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

{
    "created_epoch": "1164326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124194006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 CLAYPIT HILL RD",
            "city": "WAYLAND",
            "state": "MA",
            "postal_code": "017782004",
            "telephone_number": "508-358-7841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 BICKFORD ST",
            "address_2": "MARTHA ELIOT HEALTH CENTER",
            "city": "JAMAICA PLAIN",
            "state": "MA",
            "postal_code": "021301401",
            "telephone_number": "617-971-2312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KIM",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "76388",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3150620",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Earl Williams
• Kimisha Janay-Patterson Williams, LLMSW
• Laura Willing, LCSW
• Alexander A Wilson, MS, OTR/L
• Katherine Wilson, LIC. AC.
• Marisa Wilson
• Megan Rhoda Wilson
• Susan A Wilson, MS
• Jaclyn Winer, LICSW
• Julian Wise, MD

• Pediatrics Physician in Jamaica Plain, MA
• Providers in Jamaica Plain, MA by specialty
• Pediatrics Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.