NPIMap

Organization Active NPI

Brian Wilson MD L.L.C.

  • Pediatric Adolescent Medicine Physician
  • Hilo, HI
National Provider Identifier
1134315005
Registry record updated Sep 24, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
4143 Issued in HI
Legal business name
BRIAN WILSON MD L.L.C.
Practice address
275 Ponahawai St
Suite 106
Hilo, HI 96720-3074
Phone
(808) 961-0022
Fax
(808) 969-3852
NPI assigned
Sep 24, 2007
Last updated
Sep 24, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2007

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

Authorized official

Name
Dr. Brian J Wilson, MDNPI 1528018595
Title
Pediatrician
Phone
(808) 961-0022

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X 4143 HI Primary

Addresses

Primary practice location

275 Ponahawai St
Suite 106
Hilo, HI 96720-3074

Mailing address

275 Ponahawai St
Suite 106
Hilo, HI 96720-3074
Phone (808) 961-0022

Other identifiers 1

IdentifierTypeStateIssuer
04734301MedicaidIA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1190592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190592000000",
    "number": "1134315005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 PONAHAWAI ST",
            "address_2": "SUITE 106",
            "city": "HILO",
            "state": "HI",
            "postal_code": "967203074",
            "telephone_number": "808-961-0022",
            "fax_number": "808-969-3852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 PONAHAWAI ST",
            "address_2": "SUITE 106",
            "city": "HILO",
            "state": "HI",
            "postal_code": "967203074",
            "telephone_number": "808-961-0022",
            "fax_number": "808-969-3852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIAN WILSON MD L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-24",
        "last_updated": "2007-09-24",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PEDIATRICIAN",
        "authorized_official_telephone_number": "808-961-0022",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "HI",
            "license": "4143",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04734301",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hilo, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.