Active NPI
Gary L Wilson, MD
- Infectious Disease Physician
- Owensboro, KY
National Provider Identifier
1225025935
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Infectious Disease Physician
- License
- 42171
- Practice address
- 1000 Breckenridge St
Suite 404
Owensboro, KY 42303-0878 - Phone
- (270) 691-8050
- Fax
- (270) 691-8051
- NPI assigned
- Sep 29, 2005
- 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 |
|---|---|---|---|---|
| Infectious Disease Physician | 207RI0200X | 42171 | KY | Primary |
Addresses
Primary practice location
1000 Breckenridge St
Suite 404
Owensboro, KY 42303-0878
Mailing address
1000 Breckenridge St
Suite 404
Owensboro, KY 42303-0878
Phone (270) 691-8050
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100065360 | Medicaid | KY | |
| 000000588181 | Other | KY | BCBS PIN# |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | gwilson4850@direct.owensborohealth.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 42171 | KY | MD | Infectious Disease Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1556755200000",
"number": "1225025935",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 BRECKENRIDGE ST",
"address_2": "SUITE 404",
"city": "OWENSBORO",
"state": "KY",
"postal_code": "423030878",
"telephone_number": "270-691-8050",
"fax_number": "270-691-8051"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 BRECKENRIDGE ST",
"address_2": "SUITE 404",
"city": "OWENSBORO",
"state": "KY",
"postal_code": "423030878",
"telephone_number": "270-691-8050",
"fax_number": "270-691-8051"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "GARY",
"middle_name": "L",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-29",
"last_updated": "2019-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "207RI0200X",
"taxonomy_group": "",
"desc": "Internal Medicine, Infectious Disease",
"state": "KY",
"license": "42171",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7100065360",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PIN#",
"identifier": "000000588181",
"state": "KY"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "gwilson4850@direct.owensborohealth.org",
"affiliation": "N",
"address_1": "1000 Breckenridge St",
"address_2": "Suite 404",
"city": "Owensboro",
"state": "KY",
"country_code": "US",
"postal_code": "423030878",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Owensboro, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.