NPIMap

Individual provider Active NPI

Connie Marie Wilson, D.O.

  • Internal Medicine Physician
  • Ada, OK
National Provider Identifier
1235192881
Registry record updated Oct 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
3394 Issued in OK
Practice address
1921 Stonecipher Blvd
Ada, OK 74820
Phone
(580) 421-4570
NPI assigned
Apr 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 3394 OK Primary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 3394 OK

Addresses

Primary practice location

1921 Stonecipher Blvd
Ada, OK 74820

Mailing address

1921 Stonecipher Blvd
Ada, OK 74820
Phone (580) 421-4570

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, MO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120306001024 TX Practitioner - Emergency Medicine 1759470354 Reassigns benefits to 1 organization
I20190108003304 MO Practitioner - Emergency Medicine 1759470354 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Oklahoma State University College of Osteopathic Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

2510 Chickasaw Blvd
Ardmore, OK 73401-1341
Phone (580) 226-8181

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
3394OKMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Hospital Aurora CurrentSince Feb 9, 2019 Accepting new patients
Chickasaw Nation Division of Health Current Accepting new patients
Chickasaw Nation Division of Health CurrentSince Jan 30, 2012 Accepting new patients
Mercy Hospital Aurora CurrentSince Feb 9, 2019 Accepting new patients
Chickasaw Nation Division of Health Chickasaw Nation Medical Center CurrentSince Jan 30, 2012 Accepting new patients
Summit Medical Center Past Accepting new patients
Chickasaw Nation Division of Health Chickasaw Nation Medical Center Past Accepting new patients

Locations

500 Porter Ave
Aurora, MO 65605
Phone (417) 678-2122

1921 Stonecipher Dr
Ada, OK 74820
Phone (580) 421-4570

1001 N Country Club Rd
Ada, OK 74820
Phone (580) 421-4570

2510 Chickasaw Blvd
Ardmore, OK 73401
Phone (580) 226-8181

1600 N Washington Ave
Durant, OK 74701
Phone (580) 740-0205

1438 Hardcastle Blvd
Purcell, OK 73080
Phone (405) 527-4700

817 E 6th St
Tishomingo, OK 73460
Phone (580) 371-2392

Interoperability endpoints

  • Direct secure messaging: cwilson22528@direct.chickasawnationhealth.net

Organizations & group practices 7

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.

Hospital & facility affiliations 9

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": "1144281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761782400000",
    "number": "1235192881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1921 STONECIPHER BLVD",
            "city": "ADA",
            "state": "OK",
            "postal_code": "74820",
            "telephone_number": "580-421-4570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1921 STONECIPHER BLVD",
            "city": "ADA",
            "state": "OK",
            "postal_code": "74820",
            "telephone_number": "580-421-4570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "CONNIE",
        "middle_name": "MARIE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-06",
        "last_updated": "2025-10-30",
        "certification_date": "2025-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "3394",
            "primary": true
        },
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "OK",
            "license": "3394",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ada, OK

Sources for this page

Verify at the official NPI Registry.