Individual provider Active NPI

William Cassidy Wilson IV, MD

  • Diagnostic Radiology Physician
  • Owensboro, KY
National Provider Identifier
1366861841
Registry record updated Apr 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
53142 Issued in KY
Practice address
2200 E Parrish Ave BLDG D
Owensboro, KY 42303-1458
Phone
(270) 926-8171
NPI assigned
Apr 10, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging Physician 2085B0100X 2019009534 MO
Diagnostic Radiology Physician 2085R0202X 2019009534 MO
Diagnostic Radiology Physician 2085R0202X 53142 KY Primary

Addresses

Primary practice location

2200 E Parrish Ave BLDG D
Owensboro, KY 42303-1458

Mailing address

660 S Euclid Ave
CB 8131
Saint Louis, MO 63110-1010
Phone (314) 362-7200

Other practice location 1

2025 W Everly Brothers Blvd
Powderly, KY 42367-5401
Phone (270) 377-2600

Other practice location 2

1000 Breckenridge St Ste 101
Owensboro, KY 42303-0840
Phone (270) 926-8171

Other practice location 3

1006 Ford Ave
Owensboro, KY 42301-4677
Phone (270) 926-8171

Other practice location 4

1201 Pleasant Valley Rd
Owensboro, KY 42303-9811
Phone (270) 417-2000

Other practice location 5

510 S Kingshighway Blvd
Saint Louis, MO 63110-1016
Phone (314) 362-7200

Other practice location 6

444 S Main St
Madisonville, KY 42431-2846
Phone (270) 821-4444

Other practice location 7

1200 Barret Blvd
Henderson, KY 42420-4950
Phone (270) 844-8600

Other practice location 8

510 Ruby Dr
Madisonville, KY 42431-2168
Phone (270) 399-7900

Other identifiers 2

IdentifierTypeStateIssuer
200067605MedicaidMO
ENROLLEDMedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, KY2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190501001928 MO Practitioner - Diagnostic Radiology 5799027314 Reassigns benefits to 3 organizations
I20200807000869 KY Practitioner - Diagnostic Radiology 5799027314 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Louisville School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2200 E Parrish Ave
BLDG D
Owensboro, KY 42303-1458
Phone (270) 926-8171

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
53142KYMDDiagnostic Radiology Physician
2019009534MOMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Louisville Radiology Imaging Consultants, PLLC Diagnostic Radiology CurrentSince Mar 2, 2020 Accepting new patients
Washington University Diagnostic Radiology CurrentSince Jun 15, 2019 Accepting new patients
Owensboro Health Medical Group Inc Current Accepting new patients
Owensboro Health Medical Group, Inc CurrentSince Dec 31, 2024 Accepting new patients
Owensboro Health Medical Group Inc CurrentSince Dec 31, 2024 Accepting new patients
Miracl, LLC CurrentSince Jun 15, 2019 Accepting new patients
Radiology Imaging Consultants S C Body Imaging Past Accepting new patients

Locations (25 of 26)

1937 Momentum Pl
Chicago, IL 60689

75 Remittance Dr
Dept 1013
Chicago, IL 60675

254 Main St
Cadiz, KY 42211
Phone (270) 522-3215

440 Hopkinsville St
Greenville, KY 42345
Phone (270) 338-8000

20 E McMurtry Ave
Hartford, KY 42347
Phone (270) 504-1300

1211 Old Main St
Hartford, KY 42347
Phone (270) 298-3806

1200 Barret Blvd
Henderson, KY 42420
Phone (270) 844-8600

500 Clinic Dr
Hopkinsville, KY 42240
Phone (270) 707-3300

200 Clinic Dr
Madisonville, KY 42431
Phone (270) 821-8874

510 Ruby Dr
Madisonville, KY 42431
Phone (270) 399-7757

1851 N Main St
Madisonville, KY 42431
Phone (270) 821-7739

900 Hospital Dr
Madisonville, KY 42431
Phone (270) 326-3900

444 S Main St
Madisonville, KY 42431
Phone (270) 821-4444

811 E Parrish Ave
Owensboro, KY 42303
Phone (270) 684-8611

1006 Ford Ave
Owensboro, KY 42301
Phone (270) 417-7500

1201 Pleasant Valley Rd
Owensboro, KY 42303
Phone (270) 417-2000

2211 Mayfair Dr
Ste 102
Owensboro, KY 42301
Phone (270) 688-1351

1000 Breckenridge St
Ste 101
Owensboro, KY 42303
Phone (270) 417-7500

2200 E Parrish Ave
Bldg D
Owensboro, KY 42303
Phone (270) 688-1770

2211 Mayfair Dr
Ste 101
Owensboro, KY 42301
Phone (270) 688-1352

1010 Medical Center Dr
Powderly, KY 42367
Phone (270) 338-8000

529 Capp Harlan Rd
Tompkinsville, KY 42167
Phone (270) 487-6048

1000 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

510 S Kingshighway Blvd
Saint Louis, MO 63110
Phone (314) 362-0177

660 S Euclid Ave
#8131
Saint Louis, MO 63110
Phone (314) 362-2809

Organizations & group practices 7

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.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1397088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743638400000",
    "number": "1366861841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 S EUCLID AVE",
            "address_2": "CB 8131",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101010",
            "telephone_number": "314-362-7200",
            "fax_number": "314-747-4189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 E PARRISH AVE BLDG D",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423031458",
            "telephone_number": "270-926-8171"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2025 W Everly Brothers Blvd",
            "address_purpose": "LOCATION",
            "city": "Powderly",
            "state": "KY",
            "postal_code": "423675401",
            "country_code": "US",
            "telephone_number": "270-377-2600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 Breckenridge St Ste 101",
            "address_purpose": "LOCATION",
            "city": "Owensboro",
            "state": "KY",
            "postal_code": "423030840",
            "country_code": "US",
            "telephone_number": "270-926-8171",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1006 Ford Ave",
            "address_purpose": "LOCATION",
            "city": "Owensboro",
            "state": "KY",
            "postal_code": "423014677",
            "country_code": "US",
            "telephone_number": "270-926-8171",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1201 Pleasant Valley Rd",
            "address_purpose": "LOCATION",
            "city": "Owensboro",
            "state": "KY",
            "postal_code": "423039811",
            "country_code": "US",
            "telephone_number": "270-417-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "510 S Kingshighway Blvd",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631101016",
            "country_code": "US",
            "telephone_number": "314-362-7200",
            "fax_number": "314-747-4189",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "444 S Main St",
            "address_purpose": "LOCATION",
            "city": "Madisonville",
            "state": "KY",
            "postal_code": "424312846",
            "country_code": "US",
            "telephone_number": "270-821-4444",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1200 Barret Blvd",
            "address_purpose": "LOCATION",
            "city": "Henderson",
            "state": "KY",
            "postal_code": "424204950",
            "country_code": "US",
            "telephone_number": "270-844-8600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "510 Ruby Dr",
            "address_purpose": "LOCATION",
            "city": "Madisonville",
            "state": "KY",
            "postal_code": "424312168",
            "country_code": "US",
            "telephone_number": "270-399-7900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "WILLIAM",
        "middle_name": "CASSIDY",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-10",
        "last_updated": "2025-04-03",
        "certification_date": "2025-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "",
            "desc": "Radiology, Body Imaging",
            "state": "MO",
            "license": "2019009534",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "2019009534",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "KY",
            "license": "53142",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200067605",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Owensboro, KY

Sources for this page

Verify at the official NPI Registry.