Anna Maria Wilson, MSN, ACNP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

459195 Issued in CA

Practice address

12810 Heacock St
Suite B201
Moreno Valley, CA 92553-2854

Phone

(951) 601-2363

Fax

(951) 601-2316

NPI assigned

Jul 11, 2006

Last updated

Jul 17, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Grace Medical and Wellness ClinicGroup PAC ID 0446608087, 5 clinicians

Luther Mangoba, MD Inc.Group PAC ID 9537292594, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor of Science, Master of Science - Nursing, Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: awilson89853@direct.llu.edu
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Equanimity Hospice & Palliative Care, Inc.

  dba Hospice of IE and OC

  • Community Based Hospice Care Agency
  • Grand Terrace, CA
  • NPI 1780019612

  Operational/Managerial Control, W-2 Managing Employee

  CMS ownership

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.

• Grace Medical and Wellness Clinic

  dba Grace Medical Spa

  • Internal Medicine Physician
  • Riverside, CA
  • NPI 1689357030
  Medicare reassignment Care Compare group NPD
• Luther Mangoba, MD Inc.

  • Family Medicine Physician
  • Riverside, CA
  • NPI 1558387209
  Medicare reassignment Care Compare group NPD
• Inland Lung Institute Professional Corporation

  • Pulmonary Disease Physician
  • Corona, CA
  • NPI 1386486397
  Medicare reassignment NPD

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405555200000",
    "number": "1326073263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12810 HEACOCK ST",
            "address_2": "SUITE B201",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925532854",
            "telephone_number": "951-601-2363",
            "fax_number": "951-601-2316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12810 HEACOCK ST",
            "address_2": "SUITE B201",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925532854",
            "telephone_number": "951-601-2363",
            "fax_number": "951-601-2316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "ANNA",
        "middle_name": "MARIA",
        "name_prefix": "Ms.",
        "credential": "MSN, ACNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-11",
        "last_updated": "2014-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CA",
            "license": "459195",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lillie Mae Williams, M.D.
• Ryan Daniel Williams
• Voltaire Alphonzo Williams
• Cheryl Williamson
• Wilshire Oncology Medical Group Inc
• Erica G Wilson, PH.D.
• Jessica N Wilson
• Karen Sadewater Wilson
• Wuri Trihastuti Wimboprasetyo, RCP
• Ryan Windemuth, M.D

• Acute Care Nurse Practitioner in Moreno Valley, CA
• Providers in Moreno Valley, CA by specialty
• Acute Care Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; 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.