Sean Patrick Wilson, M.D.
Individual provider Active NPI Family Medicine Physician · Eagar, AZ
NPI 1184615650 · NPPES record last updated Nov 21, 2007
Key facts
- NPI
- 1184615650
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 32794 (AZ)
- Practice address
- 606 N Main St
Eagar, AZ 85925-9813 - Phone
- (928) 333-5333
- Fax
- (928) 333-5100
- NPI assigned
- Nov 2, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
830 E Main St
Suite 110
Springerville, AZ 85938-5353
830 E Main St Unit
Suite 110
Springerville, AZ 85938-5353
Phone (928) 333-4041
Hospital & facility affiliations
- Home Health Safford, LLC
- White Mountain Regional Medical Center
- Summit Healthcare Regional Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 24.04 of 100
- Quality
- 0
- Improvement activities
- 0
- Cost
- 80.13
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 1-10 |
| Removal of skin lesions | 141 |
| Removal of nail tissue | 11 |
| Removal or shaving of skin growth | 1-10 |
| Skin biopsy | 18 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041124000683 | AZ | Practitioner - Family Practice |
3779548177 | Practice locations: St Johns, AZ; Springerville, AZ; Show Low, AZ; Lakeside, AZ |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32794 | AZ | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brewer Chiropractic LLC | Past | Accepting new patients | |
| Billy Creek Clinic | Past |
Accepting new patients | |
| Mountain View Family Practice | Family Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 32794 | AZ | Yes |
Addresses
Primary practice location
606 N Main St
Eagar, AZ 85925-9813
Mailing address
PO Box 878
Springerville, AZ 85938-0878
Phone (928) 333-5333
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 880808 | Medicaid | AZ |
Other providers in Eagar, AZ
- Susan L Blatt DC LLC
- Mason Wade Trezise
- Sarah Lynne Webb
- White Mountain Eye Institute PLC
- White Mountain Regional Medical Center Rural Health Clinic
All providers in Eagar, AZ · Family Medicine Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 21, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.