Individual provider Active NPI

Brandon Wilkinson, DO

  • Student in an Organized Health Care Education/Training Program
  • Indianapolis, IN
National Provider Identifier
1295586253
Registry record updated Jun 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
11023624A Issued in IN
Practice address
7165 Clearvista Way
Indianapolis, IN 46256-4621
Phone
(317) 621-5700
NPI assigned
Mar 28, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Student in an Organized Health Care Education/Training Program 390200000X 11023624A IN Primary

Addresses

Primary practice location

7165 Clearvista Way
Indianapolis, IN 46256-4621

Mailing address

7165 Clearvista Way
Indianapolis, IN 46256-4621
Phone (317) 621-5700

Other identifiers 1

IdentifierTypeStateIssuer
300090840MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20240603003001 IN Order and Referring Only - PsychiatryPractitioner - Psychiatry 6608318886

National Provider Directory

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

Interoperability endpoints

  • Direct secure messaging: bwilkinson578203@ecommunitydirect.com

NPI Registry JSON

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

{
    "created_epoch": "1711584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717372800000",
    "number": "1295586253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7165 CLEARVISTA WAY",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462564621",
            "telephone_number": "317-621-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7165 CLEARVISTA WAY",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462564621",
            "telephone_number": "317-621-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILKINSON",
        "first_name": "BRANDON",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-03-28",
        "last_updated": "2024-06-03",
        "certification_date": "2024-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IN",
            "license": "11023624A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300090840",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.