NPIMap

Individual provider Active NPI

Mark Matthew Wilson, M.D.

  • Nephrology Physician
  • Alexandria, LA
National Provider Identifier
1295728087
Registry record updated Aug 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
019488 Issued in LA
Practice address
1337 Centre CT
Alexandria, LA 71301
Phone
(318) 445-9331
Fax
(318) 619-6899
NPI assigned
Aug 26, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 019488 LA Primary

Addresses

Primary practice location

1337 Centre CT
Alexandria, LA 71301

Mailing address

1337 Centre CT
Alexandria, LA 71301-3405
Phone (318) 445-9331

Other identifiers 1

IdentifierTypeStateIssuer
1934780MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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
I20100322000841 LA Practitioner - Nephrology 3577651025 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Louisiana State University School of Medicine in New Orleans, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cenla Kidney Specialists LLCGroup PAC ID 0042543035, 7 clinicians

Practice addresses (Care Compare)

2220 Worley Dr
Alexandria, LA 71301-3600
Phone 3187040001102

Hospital & facility affiliations

  • Fmcna - Alexandria Dialysis facility, Alexandria, LA, CCN 192503
  • FKC - Bayou Roberts Dialysis facility, Alexandria, LA, CCN 192753
  • FKC - Marksville Dialysis facility, Marksville, LA, CCN 192752
  • FKC - Central Louisiana Dialysis facility, Alexandria, LA, CCN 192733
  • Fmcna - Bunkie Dialysis facility, Bunkie, LA, CCN 192555
  • Christus St Frances Cabrini Hospital Hospital, Alexandria, LA, CCN 190019
  • Rapides Regional Medical Center Hospital, Alexandria, LA, CCN 190026
  • Hardtner Medical Center Hospital, Olla, LA, CCN 191315
  • Avoyelles Hospital Hospital, Marksville, LA, CCN 190099
  • Byrd Regional Hospital Hospital, Leesville, LA, CCN 190164

Merit-based Incentive Payment System (MIPS)

Final score
88.6 of 100Reported as individual
Quality
71.71
Promoting interoperability
93
Improvement activities
40
Cost
62.78

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lasalle Parish Hospital Service District #1 CurrentSince Mar 24, 2020 Accepting new patients
Cenla Kidney Specialists LLC Nephrology CurrentSince Sep 1, 2019 Accepting new patients
Lasalle Parish Hospital Service Dist No1 CurrentSince Feb 1, 2019 Accepting new patients
Lasalle Parish Hospital Service District #1 CurrentSince Feb 1, 2019 Accepting new patients
Cenla Dialysis Care LLC Nephrology PastSince Sep 1, 2020 Accepting new patients

Locations

2220 Worley Dr
Alexandria, LA 71301
Phone (216) 647-3653

1102 N Pine Rd
Olla, LA 71465
Phone (318) 495-5302

Interoperability endpoints

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

Organizations & group practices 5

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 29

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

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1125014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535328000000",
    "number": "1295728087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1337 CENTRE CT",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "713013405",
            "telephone_number": "318-445-9331",
            "fax_number": "318-619-6899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1337 CENTRE CT",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "71301",
            "telephone_number": "318-445-9331",
            "fax_number": "318-619-6899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MARK",
        "middle_name": "MATTHEW",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-26",
        "last_updated": "2018-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "LA",
            "license": "019488",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1934780",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Alexandria, LA

Sources for this page

Verify at the official NPI Registry.