Active NPI
Sallie A Wilson, DO
- Anesthesiology Physician
- Kettering, OH
National Provider Identifier
1285614545
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 34003530
- Practice address
- 3535 Southern Blvd
Kettering, OH 45429-1221 - Phone
- (937) 293-8228
- Fax
- (937) 293-8229
- NPI assigned
- Jan 20, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 34003530 | OH | Primary |
Addresses
Primary practice location
3535 Southern Blvd
Kettering, OH 45429-1221
Mailing address
3533 Southern Blvd
Suite 3400
Kettering, OH 45429-1264
Phone (937) 293-8228
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0881470 | Medicaid | OH |
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 Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34003530 | OH | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mont Green Anesthesiology Inc | Anesthesiology | Past | Accepting new patients |
| Consolidated Anesthesiologists Inc | Anesthesiology | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Anesthesiology Physician
- Dayton, OH
- NPI 1952377798
-
- Anesthesiology Physician
- Dayton, OH
- NPI 1750352159
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1399420800000",
"number": "1285614545",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3533 SOUTHERN BLVD",
"address_2": "SUITE 3400",
"city": "KETTERING",
"state": "OH",
"postal_code": "454291264",
"telephone_number": "937-293-8228",
"fax_number": "937-293-8229"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3535 SOUTHERN BLVD",
"city": "KETTERING",
"state": "OH",
"postal_code": "454291221",
"telephone_number": "937-293-8228",
"fax_number": "937-293-8229"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "SALLIE",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-20",
"last_updated": "2014-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "OH",
"license": "34003530",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0881470",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kettering, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.