Active NPI
Wilhelm Gustav Hansen, M. D.
- Geriatric Medicine (Family Medicine) Physician
- Ithaca, NY
National Provider Identifier
1154586295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Medicine (Family Medicine) Physician
- License
- 90793
- Practice address
- 1013 Hector St
Ithaca, NY 14850-2037 - Phone
- (607) 273-2643
- NPI assigned
- Jul 28, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Medicine (Family Medicine) Physician | 207QG0300X | 90793 | NY | Primary |
Addresses
Primary practice location
1013 Hector St
Ithaca, NY 14850-2037
Mailing address
1013 Hector St
Ithaca, NY 14850-2037
Phone (607) 273-2643
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 90793 | NY | MD | Geriatric Medicine (Family Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1217203200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1217203200000",
"number": "1154586295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1013 HECTOR ST",
"city": "ITHACA",
"state": "NY",
"postal_code": "148502037",
"telephone_number": "607-273-2643"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1013 HECTOR ST",
"city": "ITHACA",
"state": "NY",
"postal_code": "148502037",
"telephone_number": "607-273-2643"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANSEN",
"first_name": "WILHELM",
"middle_name": "GUSTAV",
"name_prefix": "Dr.",
"credential": "M. D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-07-28",
"last_updated": "2008-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "207QG0300X",
"taxonomy_group": "",
"desc": "Family Medicine, Geriatric Medicine",
"state": "NY",
"license": "90793",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ithaca, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.