Glen P Wilson, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

2000-314 Issued in NM

Practice address

4901 Lang Ave NE
Albuquerque, NM 87109-4495

Phone

(505) 842-8171

Fax

(505) 857-3877

NPI assigned

Jun 9, 2005

Last updated

Oct 30, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 8

Electronic endpoints 4

Medicare fee-for-service enrollment

Enrolled in NM

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

Specialty

Diagnostic Radiology

Education

Wayne State University School of Medicine, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Unm Medical Group IncGroup PAC ID 4981795267, 1,052 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Unm Hospital Hospital, Albuquerque, NM, CCN 320001

Merit-based Incentive Payment System (MIPS)

Final score

89.64 of 100Reported as group

Quality

75.49

Promoting interoperability

100

Improvement activities

40

Cost

76.92

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Unm Medical Group Inc

  • Multi-Specialty Clinic/Center
  • Albuquerque, NM
  • NPI 1831218627
  Medicare reassignment Care Compare group
• Advanced Imaging LLC

  dba High Resolution

  • Diagnostic Radiology Physician
  • Albuquerque, NM
  • NPI 1558416974
  Medicare reassignment NPD
• Radiology Associates of Albuquerque, PA

  • Diagnostic Radiology Physician
  • Albuquerque, NM
  • NPI 1881666998
  Medicare reassignment NPD
• University of New Mexico

  dba UNM Cancer Research & Treatment Center

  • Clinic/Center
  • Albuquerque, NM
  • NPI 1285714766
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Unm Hospital

  • Air Ambulance
  • Albuquerque, NM
  • NPI 1558054684

  Hospital

  Care Compare affiliation
• Unm Hospital

  • General Acute Care Hospital
  • Albuquerque, NM
  • NPI 1689747552
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730246400000",
    "number": "1285638999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 BRADBURY DR SE STE 116",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871064310",
            "telephone_number": "505-272-1476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4901 LANG AVE NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871094495",
            "telephone_number": "505-842-8171",
            "fax_number": "505-857-3877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "GLEN",
        "middle_name": "P",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-09",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NM",
            "license": "2000-314",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "2258272",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE IDTF",
            "identifier": "800521126",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "52713",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "700521102",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE IDTF",
            "identifier": "600521002",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "66463",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "45138",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "L0634",
            "state": "NM"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "UNMCCC@direct.health.unm.edu",
            "affiliation": "N",
            "address_1": "1201 Camino De Salud NE",
            "city": "Albuquerque",
            "state": "NM",
            "country_code": "US",
            "postal_code": "871024517",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "SRMC@direct.health.unm.edu",
            "affiliation": "N",
            "address_1": "3001 Broadmoor Blvd NE",
            "city": "Rio Rancho",
            "state": "NM",
            "country_code": "US",
            "postal_code": "871442100",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "UNMH@direct.health.unm.edu",
            "affiliation": "N",
            "address_1": "2211 Lomas Blvd NE",
            "city": "Albuquerque",
            "state": "NM",
            "country_code": "US",
            "postal_code": "871062719",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "UNMMG@direct.health.unm.edu",
            "affiliation": "N",
            "address_1": "800 Bradbury Dr SE Ste 116",
            "city": "Albuquerque",
            "state": "NM",
            "country_code": "US",
            "postal_code": "871064310",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Christopher Gehrig Wilson, M.D.
• Christopher Robert Wilson Jr., PHARMD
• Devin Wilson
• Dierdre Rylene Wilson, MA, LPCC
• Frazier Clethon Wilson Jr., LISW, LADAC
• Jaron Wilson
• Jason Wilson, MD
• Jennifer Wilson
• Joan Esse Wilson, MS CCC-SLP
• Joshua Wilson

• Diagnostic Radiology Physician in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Diagnostic Radiology Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.