Ivy Meg Wilson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

2893 S Cadet PL
Boise, ID 83706-5133

Phone

(208) 313-8213

NPI assigned

Jun 10, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Ms. Ivy Meg Edwards Former name

Medicare fee-for-service enrollment

Enrolled in ID

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

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Direct Orthopedic Care LLCGroup PAC ID 2163648155, 32 clinicians

Practice addresses (Care Compare)

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 and National Provider Directory roles.

• Direct Orthopedic Care LLC

  • Orthopaedic Surgery Physician
  • Boise, ID
  • NPI 1356769434
  Medicare reassignment Care Compare group NPD
• Idaho Shoulder to Hand Specialists PC

  • Orthopaedic Surgery Physician
  • Boise, ID
  • NPI 1225613375
  Medicare reassignment

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

{
    "created_epoch": "1654819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665014400000",
    "number": "1346970654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2893 S CADET PL",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837065133",
            "telephone_number": "208-313-8213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2893 S CADET PL",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837065133",
            "telephone_number": "208-313-8213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "IVY",
        "middle_name": "MEG",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-10",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2471V0106X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist, Vascular-Interventional Technology",
            "state": "ID",
            "license": "541174",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "IVY",
            "last_name": "EDWARDS",
            "middle_name": "MEG",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Dale Wilson, LCSW
• David Blair Wilson, R.PH.
• Eleanor Rose Wilson, PA-C
• Gregg A Wilson, DDS
• Hillary Guthrie Wilson, PAC
• James Brett Wilson, D.O.
• Jennifer A. Wilson, C.S.T.
• Jennifer Anne Wilson
• John Thornton Wilson, D.M.D
• Jordan Finnegan Wilson, PA-C

• Physician Assistant in Boise, ID
• Providers in Boise, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2022; 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.
• 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.