NPIMap

Individual provider Active NPI

Amy Wilson, D.O.

  • Internal Medicine Physician
  • Fort Smith, AR
National Provider Identifier
1154776409
Registry record updated Dec 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
6276 Issued in OK
Practice address
7301 Rogers Ave
Fort Smith, AR 72903-4100
Phone
(479) 314-5175
NPI assigned
Apr 24, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X E-12276 AR
Hospitalist Physician 208M00000X E-12276 AR
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 6276 OK Primary

Addresses

Primary practice location

7301 Rogers Ave
Fort Smith, AR 72903-4100

Mailing address

104 Wall St
Poteau, OK 74953-4405
Phone (918) 647-8635

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR, OK2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190624000417 AR Practitioner - HospitalistPractitioner - Internal Medicine 5890029953 Reassigns benefits to 1 organization
I20231204002618 OK Practitioner - Internal Medicine 5890029953 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
HospitalistAlso: Internal Medicine
Education
Oklahoma State University College of Osteopathic Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

104 Wall St
Eastern Oklahoma Medical Center
Poteau, OK 74953-4405
Phone (918) 647-8161

105 Wall St
Eastern Oklahoma Medical Center Pro
Poteau, OK 74953-4433
Phone (918) 635-3402

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6276OKMDGeneral Practice Dentistry
E-12276ARMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Fort Smith Communities CurrentSince Aug 1, 2019 Accepting new patients
Mercy Clinic Fort Smith Communities CurrentSince Aug 1, 2019 Accepting new patients
Leflore County Hospital Authority Current Accepting new patients
Leflore County Hospital Authority CurrentSince Nov 1, 2023 Accepting new patients
Heavener Manor, LLC Past Accepting new patients
Spiro Nursing Home, Inc. Past Accepting new patients
Pocola Nursing Center LLC Past Accepting new patients
Leflore County Hospital Authority Past Accepting new patients

Locations

7001 Rogers Ave
Ste 200
Fort Smith, AR 72903
Phone (479) 314-4620

7301 Rogers Ave
Fort Smith, AR 72903
Phone (479) 314-4600

105 Wall St
Poteau, OK 74953
Phone (918) 635-3100

104 Wall St
Poteau, OK 74953
Phone (918) 635-3578

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Pocola Health and RehabPocola, OK, CCN 375188 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Oct 16, 2023
May 14, 2025
Complete Hospice CareMuskogee, OK, CCN 371710 Hospice Contracted Managing Employee (100%) Mar 23, 2024

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 8

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 9

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": "1461456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702944000000",
    "number": "1154776409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 WALL ST",
            "city": "POTEAU",
            "state": "OK",
            "postal_code": "749534405",
            "telephone_number": "918-647-8635",
            "fax_number": "918-635-3191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7301 ROGERS AVE",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729034100",
            "telephone_number": "479-314-5175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "AMY",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-24",
        "last_updated": "2023-12-19",
        "certification_date": "2023-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AR",
            "license": "E-12276",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "AR",
            "license": "E-12276",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "6276",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Smith, AR

Sources for this page

Verify at the official NPI Registry.