Individual provider Active NPI

Jeremiah J Wilson, MD

  • Family Medicine Physician
  • Augusta, GA
National Provider Identifier
1285894352
Registry record updated Jan 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
066105 Issued in GA
Practice address
127 Telfair St
Augusta, GA 30901-2590
Phone
(706) 922-0600
Fax
(706) 922-0604
NPI assigned
Jun 12, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 066105 GA Primary
Family Medicine Physician 207Q00000X MD30978 SC

Addresses

Primary practice location

127 Telfair St
Augusta, GA 30901-2590

Mailing address

PO Box 2344
Augusta, GA 30903-2344
Phone (706) 922-0600

Other identifiers 1

IdentifierTypeStateIssuer
003112490AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20110811000413 GA Practitioner - Family Practice 8123171022 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Louisville School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1226 Dantignac St
Augusta, GA 30901-2788
Phone (706) 922-0600

1238 Dantignac St
Augusta, GA 30901-2788
Phone (706) 822-0600

127 Telfair St
Augusta, GA 30901-2590
Phone (706) 922-0600

1321 Interstate Pkwy
Augusta, GA 30909-5626
Phone (706) 945-0810

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
066105GAMDFamily Medicine Physician
MD30978SCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Christ Community Health Services Augusta, Inc. Family Medicine CurrentSince Aug 1, 2011 Accepting new patients
Christ Community Health Services Augusta, Inc CurrentSince Aug 1, 2011 Accepting new patients
Christ Community Health Services Augusta, Inc Past Accepting new patients
Christ Community Health Services Augusta, Inc Past Accepting new patients
Christ Community Health Services Augusta, Inc Past Accepting new patients

Locations

127 Telfair St
Augusta, GA 30901
Phone (706) 922-0600

1226 Dantignac St
Augusta, GA 30901
Phone (706) 922-0600

1226 Dantignac St
#D
Augusta, GA 30901

Interoperability endpoints

  • Direct secure messaging: jeremy.wilson@cchsa.eclinicaldirectplus.com

Organizations & group practices 6

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 2

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": "1213228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1285894352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2344",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309032344",
            "telephone_number": "706-922-0600",
            "fax_number": "706-922-0604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 TELFAIR ST",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309012590",
            "telephone_number": "706-922-0600",
            "fax_number": "706-922-0604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JEREMIAH",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-12",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "066105",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "MD30978",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003112490A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

Verify at the official NPI Registry.