Derrick Dionne Wilson

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

License

302R000X Issued in NC

Practice address

500 W 5TH St Ste 800
Winston Salem, NC 27101-3131

Phone

(800) 571-8308

NPI assigned

May 3, 2024

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Derrick Dionne Wilson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Three Pillow System

  • Multi-Specialty Clinic/Center
  • Winston Salem, NC
  • NPI 1992553564
  NPD Authorized official

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

{
    "created_epoch": "1714694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714694400000",
    "number": "1144077454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W 5TH ST STE 800",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271013131",
            "telephone_number": "800-571-8308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W 5TH ST STE 800",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271013131",
            "telephone_number": "800-571-8308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "DERRICK",
        "middle_name": "DIONNE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-05-03",
        "last_updated": "2024-05-03",
        "certification_date": "2024-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "NC",
            "license": "302R000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DERRICK",
            "last_name": "WILSON",
            "middle_name": "DIONNE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Christopher Samuel Wilson
• Courtney Wilson
• Damon William Wilson, PA
• Daniel Culp Wilson, MD
• Darcie Rae Wilson, PA-C
• Emily Gulick Wilson, M.S.
• Emily Meyer Wilson, MD
• Hadley Kitchin Wilson, MD
• Harper Lee Wilson, MD
• Heather Johnston Wilson, MSN, APRN, FNP-C

• Health Maintenance Organization in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Health Maintenance Organization in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2024; 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.