NPIMap

Individual provider Active NPI

John D Wilson, MD

  • Diagnostic Radiology Physician
  • Desoto, TX
National Provider Identifier
1144204652
Registry record updated Jun 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
J7730 Issued in TX
Practice address
1750 North Hampton Road
Desoto, TX 75115
Phone
(817) 321-0404
NPI assigned
Nov 30, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X J7730 TX Primary

Addresses

Primary practice location

1750 North Hampton Road
Desoto, TX 75115

Mailing address

816 W Cannon St
Fort Worth, TX 76104-3146
Phone (817) 321-0404

Other identifiers 2

IdentifierTypeStateIssuer
041641403MedicaidTX
041641402MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040127001049 TX Practitioner - Diagnostic RadiologyPractitioner - Other (Physician) 0749183903 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of North Carolina at Chapel Hill School of Medicine, 1988
Medicare assignment
May accept Medicare assignment
Group practices
Radiology Associates of North Texas PAGroup PAC ID 7911897301, 340 clinicians
Methodist-CdiGroup PAC ID 3072836600, 43 clinicians

Practice addresses (Care Compare)

17980 Dallas Pkwy
Suite 200
Dallas, TX 75287-6817
Phone (817) 321-0937

7300 Eldorado Pkwy
Suite 170
McKinney, TX 75070-7895
Phone (972) 920-0150

Hospital & facility affiliations

  • Methodist Dallas Medical Center Hospital, Dallas, TX, CCN 450051
  • Methodist Charlton Medical Center Hospital, Dallas, TX, CCN 450723
  • Lubbock Heart Hospital LP Hospital, Lubbock, TX, CCN 450876
  • Methodist Midlothian Medical Center Hospital, Midlothian, TX, CCN 670300
  • Methodist McKinney Hospital Hospital, McKinney, TX, CCN 670069

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Radiology Associates of North Texas PA Diagnostic Radiology CurrentSince Mar 1, 2016 Accepting new patients
Methodist-Cdi Diagnostic Radiology CurrentSince Jan 18, 2016 Accepting new patients
Methodist-Cdi Diagnostic Radiology CurrentSince Jan 18, 2016 Accepting new patients
Methodist-Cdi Diagnostic Radiology Current Accepting new patients
Clinical Care in Radiology Past Accepting new patients
Medical Imaging of Dallas, LLP PastSince Jun 30, 2004 Accepting new patients

Locations

17980 Dallas Pkwy
Ste 200
Dallas, TX 75287
Phone (972) 248-1303

1441 N Beckley Ave
Dallas, TX 75203
Phone (214) 712-2429

1750 N Hampton Rd
Desoto, TX 75115
Phone (214) 420-5400

816 W Cannon St
Ft Worth, TX 76104
Phone (817) 321-0312

2975 E Broad St
Ste 101
Mansfield, TX 76063
Phone (214) 420-5445

7300 Eldorado Pkwy
Ste 170
McKinney, TX 75070
Phone (972) 920-0150

8080 Independence Pkwy
Ste 105
Plano, TX 75025
Phone (972) 208-1858

5425 W Spring Creek Pkwy
Ste 110
Plano, TX 75024
Phone (214) 718-0100

Organizations & group practices 7

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.

Hospital & facility affiliations 5

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": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529625600000",
    "number": "1144204652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "816 W CANNON ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043146",
            "telephone_number": "817-321-0404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 NORTH HAMPTON ROAD",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "75115",
            "telephone_number": "817-321-0404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JOHN",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-30",
        "last_updated": "2018-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "J7730",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "041641403",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "041641402",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Desoto, TX

Sources for this page

Verify at the official NPI Registry.