Keith A Wilson, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

35-052784 Issued in OH

Practice address

1075 W Western Reserve Rd
Poland, OH 44514-3541

Phone

(330) 884-6584

NPI assigned

Aug 12, 2005

Last updated

Jan 14, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 9

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Ophthalmology

Education

Clvlnd Clinic Lerner College of Med of Case WSTN RSV University, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eye Care Associates, IncGroup PAC ID 0042350118, 14 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

82.55 of 100Reported as group

Quality

93.28

Promoting interoperability

100

Improvement activities

40

Cost

48.55

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kwilson@ecaoh.intellechartdirect.net
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: kwilson34572@direct.bsmhealth.org
• Direct secure messaging: keith.wilson.p1@direct.eyecare.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Eye Care Associates, Inc

  • Ophthalmology Physician
  • Youngstown, OH
  • NPI 1447203088
  Medicare reassignment Care Compare group NPD
• Center for Advanced Eye Surgery, LTD

  • Ambulatory Surgical Clinic/Center
  • Poland, OH
  • NPI 1689657058
  Medicare reassignment NPD
• Eye Care Associates, Inc

  • Optometrist
  • Austintown, OH
  • NPI 1023721297

  Ophthalmology

  NPD
• Eye Care Associates, Inc

  • Ophthalmology Physician
  • Warren, OH
  • NPI 1245315068
  NPD

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

{
    "created_epoch": "1123804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736812800000",
    "number": "1164424743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 DUTTON DR",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445021818",
            "telephone_number": "330-746-7691",
            "fax_number": "330-743-8368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 W WESTERN RESERVE RD",
            "city": "POLAND",
            "state": "OH",
            "postal_code": "445143541",
            "telephone_number": "330-884-6584"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1031 W Western Reserve Rd",
            "address_purpose": "LOCATION",
            "city": "Poland",
            "state": "OH",
            "postal_code": "445143541",
            "country_code": "US",
            "telephone_number": "330-746-7691",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15655 State Route 170 Ste O",
            "address_purpose": "LOCATION",
            "city": "East Liverpool",
            "state": "OH",
            "postal_code": "439209672",
            "country_code": "US",
            "telephone_number": "330-746-7691",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10 Dutton Dr",
            "address_purpose": "LOCATION",
            "city": "Youngstown",
            "state": "OH",
            "postal_code": "445021818",
            "country_code": "US",
            "telephone_number": "330-746-7691",
            "fax_number": "330-743-8368",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KEITH",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-12",
        "last_updated": "2025-01-14",
        "certification_date": "2025-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "OH",
            "license": "35-052784",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "0095849000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "180011155",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4096251",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "0800328",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUALCHOICE",
            "identifier": "82799",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUMMACARE",
            "identifier": "Z52784",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE",
            "identifier": "438220",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000126322",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0624695",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Western Reserve Joint Fire District
• Karl Fredric Wieneke Jr., M.D.
• Bonnie Katherina Wilcox, D.C.
• David E Wilhelm, LSW
• Rebecca Anne Depietro Williams, PT
• Jeffrey Lawrance Wiltrout, LSW
• James Joseph Wiscott Sr., MA, RBT
• Devin Wade Witt, P.T.
• Wittenauer Pharmacy
• Kathleen W Wolanin, DMD

• Ophthalmology Physician in Poland, OH
• Providers in Poland, OH by specialty
• Ophthalmology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.