Individual provider Active NPI

Michael Wilson, MD

  • Family Medicine Physician
  • Andover, KS
National Provider Identifier
1255340337
Registry record updated Jul 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25289 Issued in KS
Practice address
612 N Andover Rd
Andover, KS 67002-9778
Phone
(316) 733-6618
Fax
(316) 733-5299
NPI assigned
Aug 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 25289 KS Primary

Addresses

Primary practice location

612 N Andover Rd
Andover, KS 67002-9778

Mailing address

PO Box 8035
Wichita, KS 67208-0035
Phone (316) 689-9135

Other identifiers 5

IdentifierTypeStateIssuer
2807OtherKSPHS
041801OtherKSBCBS
100842OtherKSHPK
16949OtherKSCOVENTRY
11084898OtherKSMULTIPLAN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050421001325 KS Practitioner - Family Practice 8123066941 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Kansas School of Med (KC/Wich/Sal), 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ascension Medical Group Via Christi PAGroup PAC ID 2961314497, 184 clinicians

Practice addresses (Care Compare)

1640 E Tall Tree Rd
Via Christi Clinic PA
Derby, KS 67037-2000
Phone (316) 789-8222

1947 N Founders Cir
Via Christi Clinic PA
Wichita, KS 67206-3548
Phone (316) 613-4640

3311 E Murdock St
Wichita, KS 67208-3054
Phone (316) 689-9349

612 N Andover Rd
Via Christi Clinic PA
Andover, KS 67002-9778
Phone (316) 733-6618

818 N Carriage Pkwy
Wichita, KS 67208-4500
Phone (316) 689-9153

Hospital & facility affiliations

  • Ascension at Home Home health agency, Wichita, KS, CCN 177117
  • Faith Home Health Home health agency, Wichita, KS, CCN 178112
  • Specialized Home Care Home health agency, Wichita, KS, CCN 178111
  • Ascension Via Christi Hospitals Wichita, Inc. Hospital, Wichita, KS, CCN 170122
  • Ascension Via Christi Rehabilitation Hospital, Inc Inpatient rehabilitation facility, Wichita, KS, CCN 173028

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions21
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25289KSMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Medical Group Via Christi, PA CurrentSince Aug 1, 1996 Accepting new patients
Ascension Medical Group Via Christi, PA CurrentSince Aug 1, 1996 Accepting new patients
Ozarks Medical Center Family Medicine Past Accepting new patients
Summit Medical Center Past Accepting new patients
Ascension Medical Group Via Christi, PA Past Accepting new patients

Locations

612 N Andover Rd
Andover, KS 67002
Phone (316) 613-4976

3311 E Murdock St
Wichita, KS 67208
Phone (316) 689-9107

1100 N Saint Francis Ave
Ste 400
Wichita, KS 67214

Organizations & group practices 5

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 5

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": "1154822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184544000000",
    "number": "1255340337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8035",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672080035",
            "telephone_number": "316-689-9135",
            "fax_number": "316-689-9102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 N ANDOVER RD",
            "city": "ANDOVER",
            "state": "KS",
            "postal_code": "670029778",
            "telephone_number": "316-733-6618",
            "fax_number": "316-733-5299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-06",
        "last_updated": "2007-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "25289",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHS",
            "identifier": "2807",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "041801",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HPK",
            "identifier": "100842",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COVENTRY",
            "identifier": "16949",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MULTIPLAN",
            "identifier": "11084898",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Andover, KS

Sources for this page

Verify at the official NPI Registry.