Individual provider Active NPI

Thomas Charles Wilson, DPM

  • Podiatrist
  • Melbourne, FL
National Provider Identifier
1184064834
Registry record updated May 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
PO3765 Issued in FL
Practice address
1515 Dr Martin Luther King Jr Blvd
Melbourne, FL 32901-2946
Phone
(321) 723-3500
Fax
(321) 723-1945
NPI assigned
Jun 26, 2013
Last updated
May 12, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X SC006507 PA
Foot & Ankle Surgery Podiatrist 213ES0103X PO3765 FL
Podiatrist 213E00000X PO3765 FL Primary

Addresses

Primary practice location

1515 Dr Martin Luther King Jr Blvd
Melbourne, FL 32901-2946

Mailing address

1515 Dr Martin Luther King Jr Blvd
Melbourne, FL 32901-2946
Phone (321) 723-3500

Other practice location 1

1310 W Eau Gallie Blvd Ste E
Melbourne, FL 32935-5300
Phone (321) 255-3338

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160629001261 FL Practitioner - Podiatry 3476844044 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Barry University School of Podiatric Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Melbourne Podiatry Associates, P.a.Group PAC ID 2769567882, 4 clinicians

Practice addresses (Care Compare)

1310 W Eau Gallie Blvd
Melbourne, FL 32935-5300
Phone (321) 255-3338

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.5 of 100Reported as group
Quality
95
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Melanoma (skin cancer) excision1-10
Removal of tissue110
Removal of skin lesions109
Removal of nail tissue54
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SC006507PAMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Melbourne Podiatry Associates, P.a. Podiatrist CurrentSince Jul 1, 2016 Accepting new patients
Briant G. Moyles D.P.M., P.a. Podiatrist CurrentSince Jul 1, 2016 Accepting new patients

Locations

1310 W Eau Gallie Blvd
Melbourne, FL 32935
Phone (321) 254-3630

1310 W Eau Gallie Blvd
Ste E
Melbourne, FL 32935
Phone (321) 255-3338

1515 Dr Martin Luther King Jr Blvd
Melbourne, FL 32901
Phone (321) 723-3500

211 E New Haven Ave
Melbourne, FL 32901
Phone (321) 500-4263

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DIHJAA/Endpoint/DIHJAA
  • Direct secure messaging: twilson71528@epicdirect.hf.org

Organizations & group practices 2

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.

Hospital & facility affiliations 2

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": "1372204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683849600000",
    "number": "1184064834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 DR MARTIN LUTHER KING JR BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329012946",
            "telephone_number": "321-723-3500",
            "fax_number": "321-723-1945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 DR MARTIN LUTHER KING JR BLVD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329012946",
            "telephone_number": "321-723-3500",
            "fax_number": "321-723-1945"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1310 W Eau Gallie Blvd Ste E",
            "address_purpose": "LOCATION",
            "city": "Melbourne",
            "state": "FL",
            "postal_code": "329355300",
            "country_code": "US",
            "telephone_number": "321-255-3338",
            "fax_number": "321-253-9643",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "THOMAS",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-26",
        "last_updated": "2023-05-12",
        "certification_date": "2023-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "PA",
            "license": "SC006507",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "FL",
            "license": "PO3765",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "FL",
            "license": "PO3765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

Verify at the official NPI Registry.