Marty C Wilson, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

085004959 Issued in IL

Practice address

1301 S Koke Mill Rd
Springfield, IL 62711-9252

Phone

(217) 547-9100

Fax

(217) 547-9236

NPI assigned

Dec 13, 2013

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

Medicare fee-for-service enrollment

Enrolled in IL

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 1

Specialty

Physician Assistant

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Orthopaedic Center of IlGroup PAC ID 0143299628, 29 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorial Medical Center Hospital, Springfield, IL, CCN 140148
• St Johns Hospital Hospital, Springfield, IL, CCN 140053

Merit-based Incentive Payment System (MIPS)

Final score

63.56 of 100Reported as group

Quality

57.12

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: martywilson@oci.allscriptsdirect.net
• Direct secure messaging: mcw001@oci2123.srs-direct.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.

• Orthopaedic Center of Il

  • Orthopaedic Surgery Physician
  • Springfield, IL
  • NPI 1154300572
  Medicare reassignment Care Compare group
• Orthopaedic Center of Illinois

  • Durable Medical Equipment & Medical Supplies
  • Springfield, IL
  • NPI 1144372798
  NPD (past)

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

• Memorial Medical Center

  • General Acute Care Hospital
  • Springfield, IL
  • NPI 1255317590
  Care Compare affiliation
• St Johns Hospital of the Hospital Sisters of the Third Order of St F

  • General Acute Care Hospital
  • Springfield, IL
  • NPI 1205818481
  Care Compare affiliation

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

{
    "created_epoch": "1386892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586736000000",
    "number": "1184045338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 S KOKE MILL RD",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627119252",
            "telephone_number": "217-547-9100",
            "fax_number": "217-547-9236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 S KOKE MILL RD",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627119252",
            "telephone_number": "217-547-9100",
            "fax_number": "217-547-9236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MARTY",
        "middle_name": "C",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-12-13",
        "last_updated": "2020-04-13",
        "certification_date": "2020-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "085004959",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bradley A Wilson, MD
• Cawonda Ranee Wilson, PMHNP-BC
• Jennifer C Wilson, CRNA
• Laura Wilson, C-OTA
• Marla Kay Wilson, DPM
• Michael J. Wilson, M.D.
• Morgan Wilson, MD
• Ronnie James Wilson Jr.
• Shannon Elaine Wilson, R.N.
• TJ Lamar Wilson, MD

• Surgical Physician Assistant in Springfield, IL
• Providers in Springfield, IL by specialty
• Surgical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2020; 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.