Active NPI
James Gordon Wilson II, D.M.D.
- Periodontics
- Tampa, FL
National Provider Identifier
1356757470
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- DN0013537
- Practice address
- 1810 S Macdill Ave
Tampa, FL 33629-5960 - Phone
- (813) 251-0770
- Fax
- (813) 251-0771
- NPI assigned
- Jul 9, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | DN0013537 | FL | Primary |
Addresses
Primary practice location
1810 S Macdill Ave
Tampa, FL 33629-5960
Mailing address
1810 S Macdill Ave
Tampa, FL 33629-5960
Phone (813) 251-0770
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150217001114 | FL | Order and Referring Only - Dentist | 9638494586 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN0013537 | FL | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1404864000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404864000000",
"number": "1356757470",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1810 S MACDILL AVE",
"city": "TAMPA",
"state": "FL",
"postal_code": "336295960",
"telephone_number": "813-251-0770",
"fax_number": "813-251-0771"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1810 S MACDILL AVE",
"city": "TAMPA",
"state": "FL",
"postal_code": "336295960",
"telephone_number": "813-251-0770",
"fax_number": "813-251-0771"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JAMES",
"middle_name": "GORDON",
"name_prefix": "Dr.",
"name_suffix": "II",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-07-09",
"last_updated": "2014-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "FL",
"license": "DN0013537",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2014; 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.