NPIMap

Individual provider Active NPI

Charles Richard Wilson, M.D.

  • Surgery Physician
  • Saint Helena, CA
National Provider Identifier
1295933471
Registry record updated Sep 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
C164914 Issued in CA
Practice address
6 Woodland Rd Ste 205
Saint Helena, CA 94574-9501
Phone
(707) 963-6111
Fax
(707) 963-6161
NPI assigned
Jul 10, 2007
Last updated
Sep 13, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 47551 MT
Surgery Physician 208600000X C164914 CA Primary

Addresses

Primary practice location

6 Woodland Rd Ste 205
Saint Helena, CA 94574-9501

Mailing address

1400 29TH St S
Great Falls, MT 59405-5315
Phone (406) 454-2171

Other practice location 1

3000 15th Ave S
Great Falls, MT 59405-5240
Phone (406) 454-2171

Other identifiers 2

IdentifierTypeStateIssuer
03026446MedicaidNY
1022802MedicaidVT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20191022000761 CA Practitioner - General Surgery 4486722840 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

6 Woodland Rd
Suite 205
Saint Helena, CA 94574-9501
Phone (707) 963-6448

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.74 of 100Reported as group
Quality
94
Promoting interoperability
92
Improvement activities
40
Cost
65.12

Merit-based Incentive Payment System (MIPS)

Final score
95.77 of 100Reported as apm
Quality
81.54
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy43
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)17
Mastectomy1-10
Coronary artery bypass graft (CABG)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux43
Melanoma (skin cancer) excision1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C164914CAMDSurgery Physician
47551MTMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health Physicians Network Current Accepting new patients
Adventist Health Physicians Network CurrentSince Nov 1, 2019 Accepting new patients
Adventist Health Physicians Network Surgery CurrentSince Nov 1, 2019 Accepting new patients
Michael R. Cosenza, DPM, Inc. PastSince Feb 28, 2018 Accepting new patients
Grant Memorial Hospital Past Accepting new patients
St. Helena Hospital Past Accepting new patients
Canton Potsdam Hospital PastSince Aug 1, 2014 Accepting new patients
Benefis Hospitals, Inc. Past Accepting new patients

Locations

913 Washington St
Calistoga, CA 94515
Phone (707) 942-0844

1524 W Lacey Blvd
Ste 101
Hanford, CA 93230
Phone (559) 583-4695

1100 Trancas St
Ste 250
Napa, CA 94558
Phone (707) 253-1135

6 Woodland Rd
Ste 205
Saint Helena, CA 94574
Phone (707) 963-6111

Interoperability endpoints

  • Direct secure messaging: cwilson1@yourcarecommunity.org

Organizations & group practices 8

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.

Hospital & facility affiliations 5

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": "1184025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568332800000",
    "number": "1295933471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 29TH ST S",
            "city": "GREAT FALLS",
            "state": "MT",
            "postal_code": "594055315",
            "telephone_number": "406-454-2171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 WOODLAND RD STE 205",
            "city": "SAINT HELENA",
            "state": "CA",
            "postal_code": "945749501",
            "telephone_number": "707-963-6111",
            "fax_number": "707-963-6161"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3000 15th Ave S",
            "address_purpose": "LOCATION",
            "city": "Great Falls",
            "state": "MT",
            "postal_code": "594055240",
            "country_code": "US",
            "telephone_number": "406-454-2171",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "CHARLES",
        "middle_name": "RICHARD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-10",
        "last_updated": "2019-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MT",
            "license": "47551",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "C164914",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03026446",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1022802",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Helena, CA

Sources for this page

Verify at the official NPI Registry.