Destonee Wilson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA12177 Issued in TX

Practice address

1650 S Beach St
Fort Worth, TX 76105

Phone

(817) 702-1100

Fax

(817) 702-6124

NPI assigned

Sep 6, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in UT, TX2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Privia Medical Group Gulf Coast PLLCGroup PAC ID 4688999022, 511 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Warm Springs Rehab Hospital of San Antonio LLC Inpatient rehabilitation facility, San Antonio, TX, CCN 453035

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: destonee.wilson.1@8042.direct.athenahealth.com

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.

• Privia Medical Group Gulf Coast, PLLC

  • Obstetrics & Gynecology Physician
  • Houston, TX
  • NPI 1578969465
  Medicare reassignment Care Compare group NPD
• Acclaim Physician Group, Inc

  • Internal Medicine Physician
  • Fort Worth, TX
  • NPI 1780076562
  Medicare reassignment
• Foothill Clinic, LLC

  • Family Medicine Physician
  • Salt Lake City, UT
  • NPI 1407947005
  Medicare reassignment
• Privia Medical Group Gulf Coast PLLC

  • Interventional Pain Medicine Physician
  • San Antonio, TX
  • NPI 1457167033
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Post Acute Medical at San Antonio LLC

  • Rehabilitation Hospital
  • San Antonio, TX
  • NPI 1376588228

  Inpatient rehabilitation facility

  Care Compare affiliation

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

{
    "created_epoch": "1504656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541548800000",
    "number": "1174041578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 732973",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753732973",
            "telephone_number": "817-702-8450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 S BEACH ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "76105",
            "telephone_number": "817-702-1100",
            "fax_number": "817-702-6124"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2295 S Foothill Dr",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841094000",
            "country_code": "US",
            "telephone_number": "801-486-3021",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6360 S 3000 E Ste 100",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841216924",
            "country_code": "US",
            "telephone_number": "801-365-1032",
            "fax_number": "801-365-1036",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2295 S Foothill Dr",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841094000",
            "country_code": "US",
            "telephone_number": "801-486-3021",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13953 S Bangerter Pkwy",
            "address_purpose": "LOCATION",
            "city": "Draper",
            "state": "UT",
            "postal_code": "840205429",
            "country_code": "US",
            "telephone_number": "385-900-4090",
            "fax_number": "801-365-1033",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "DESTONEE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-06",
        "last_updated": "2018-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "279726-1206",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA12177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtney Lynn Wilson, NNP
• Cynthia Blair Wilson, PT, DPT
• Daphne Elizabeth Wilson, MSSW
• David B Wilson, M.D.
• David Bradford Wilson, LSA, CST/CFA
• Diana Elizabeth Wilson, M.D.
• Donnie P. Wilson, M.D.
• Isaac Wilson, RN
• Jo Lynn Wilson, CRNA
• Justine K Wilson, PA-C

• Physician Assistant in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 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.
• 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.