NPIMap

Individual provider Active NPI

James Cornelius Wilson III

  • Family Medicine Physician
  • West Brookfield, MA
National Provider Identifier
1285622365
Registry record updated Feb 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
219183 Issued in MA
Practice address
46 N Main St
West Brookfield, MA 01585-3232
Phone
(508) 867-8977
NPI assigned
Oct 12, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 19, 2016

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 219183 MA Primary

Addresses

Primary practice location

46 N Main St
West Brookfield, MA 01585-3232

Mailing address

68 Ware St
West Brookfield, MA 01585-3136
Phone (508) 867-8977

Other identifiers 1

IdentifierTypeStateIssuer
2096200MedicaidMA

Other names 1

  • Dr. James Cornelius Wilson III Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041102001044 MA Practitioner - Family Practice 1850353731 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
State University of New York at Stony Brook, School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
West Brookfield Family PracticeGroup PAC ID 2466509625, 2 clinicians

Practice addresses (Care Compare)

46 N Main St
W Brookfield, MA 01585-3232
Phone (508) 867-8977

Hospital & facility affiliations

  • Elara Caring Home health agency, Braintree, MA, CCN 227475
  • Care Central Vna & Hospice Inc Home health agency, Gardner, MA, CCN 227003
  • Umass Memorial Health - Harrington Hospital Hospital, Southbridge, MA, CCN 220019
  • Baystate Wing Hospital Hospital, Palmer, MA, CCN 220030
  • Baystate Medical Center Hospital, Springfield, MA, CCN 220077
  • Umass Memorial Medical Center/University Campus Hospital, Worcester, MA, CCN 220163

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
219183MAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
West Brookfield Family Practice Family Medicine CurrentSince Jan 1, 2012 Accepting new patients
Baystate Medical Practices, Inc Past Accepting new patients
Baystate Affiliated Practice Organization Family Medicine Past Accepting new patients

Locations

46 N Main St
West Brookfield, MA 01585
Phone (508) 867-8977

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DACACA
  • FHIR API: https://fhir4.healow.com/fhir/r4/DACACA/Endpoint/DACACA

Organizations & group practices 3

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 7

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": "1129075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455840000000",
    "number": "1285622365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "68 WARE ST",
            "city": "WEST BROOKFIELD",
            "state": "MA",
            "postal_code": "015853136",
            "telephone_number": "508-867-8977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46 N MAIN ST",
            "city": "WEST BROOKFIELD",
            "state": "MA",
            "postal_code": "015853232",
            "telephone_number": "508-867-8977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JAMES",
        "middle_name": "CORNELIUS",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-12",
        "last_updated": "2016-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "219183",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2096200",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAMES",
            "last_name": "WILSON",
            "middle_name": "CORNELIUS",
            "prefix": "DR.",
            "suffix": "III",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in West Brookfield, MA

Sources for this page

Verify at the official NPI Registry.