Christine Wilson, P.A.-C.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA01463 Issued in OR

Practice address

3896 Beverly Ave. SE
BLDG. J, Ste. 40
Salem, OR 97305-1374

Phone

(503) 588-0076

Fax

(503) 588-0531

NPI assigned

Oct 4, 2006

Last updated

Nov 29, 2011By 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 2

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• County of Sacramento

  dba Sacramento County Health Center

  • Federally Qualified Health Center (FQHC)
  • Sacramento, CA
  • NPI 1366513061
  Medicare reassignment NPD
• Orangevale Family Medical Clinic, Inc.

  • Family Medicine Physician
  • Orangevale, CA
  • NPI 1285609792
  NPD (past) Authorized official
• County of Sacramento

  • Radiology Clinic/Center
  • Sacramento, CA
  • NPI 1508936030
  NPD
• Santiam Memorial Hospital

  dba Santiam Medical Clinic

  • Family Medicine Physician
  • Mill City, OR
  • NPI 1205048097
  NPD (past)
• Santiam Memorial Hospital

  dba Santiam Medical Clinic

  • Rural Health Clinic/Center
  • Mill City, OR
  • NPI 1396131389
  NPD (past)
• Santiam Memorial Hospital

  dba Santiam Health & Wellness Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Stayton, OR
  • NPI 1801787171
  NPD (past)

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322524800000",
    "number": "1336234277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 N 4TH STREET",
            "address_2": "SUITE 202",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989010190",
            "telephone_number": "509-248-3782",
            "fax_number": "503-588-0531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3896 BEVERLY AVE. SE",
            "address_2": "BLDG. J, STE. 40",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973051374",
            "telephone_number": "503-588-0076",
            "fax_number": "503-588-0531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "CHRISTINE",
        "name_prefix": "Ms.",
        "credential": "P.A.-C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2011-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA01463",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA15054",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE OREGON",
            "identifier": "PA01463",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David G Willis, DMD
• Willson House (Willson House Residential Care Facility)
• Adrienne Erin Wilson, CLD, CPD, CCE, NCS
• Benjamin R Wilson, MD
• Charles Wilson, MD
• Colleen Joy Wilson, FNP-C
• Halle L. Wilson, DPT, OCS
• Jennifer Wilson
• Kathleen Marie Wilson
• Kaylin Wilson

• Physician Assistant in Salem, OR
• Providers in Salem, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.