Active NPI
Ryan David Wilson
- Social Worker
- Redlands, CA
National Provider Identifier
1174017792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- Practice address
- 26001 Redlands Blvd
Redlands, CA 92373-7762 - Phone
- (951) 378-2277
- NPI assigned
- Jun 18, 2018
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Social Worker | 104100000X | CA | Primary |
Addresses
Primary practice location
26001 Redlands Blvd
Redlands, CA 92373-7762
Mailing address
12297 Paseo del Sol Way
Moreno Valley, CA 92557-7516
Phone (951) 378-2277
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1529280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529280000000",
"number": "1174017792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12297 PASEO DEL SOL WAY",
"city": "MORENO VALLEY",
"state": "CA",
"postal_code": "925577516",
"telephone_number": "951-378-2277"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26001 REDLANDS BLVD",
"city": "REDLANDS",
"state": "CA",
"postal_code": "923737762",
"telephone_number": "951-378-2277"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "RYAN",
"middle_name": "DAVID",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-18",
"last_updated": "2018-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Redlands, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2018; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.