Mark D Wilson, M.D.

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

C135134 Issued in CA

Practice address

39000 Bob Hope Dr
Wright BLDG #301
Rancho Mirage, CA 92270-3221

Phone

(760) 340-4566

Fax

(760) 340-2481

NPI assigned

Aug 22, 2005

Sex

Male

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 5

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Otolaryngology

Education

University of Michigan Medical School, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Desert Ear Nose and Throat Medical Group IncGroup PAC ID 6002909322, 8 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Eisenhower Medical Center Hospital, Rancho Mirage, CA, CCN 050573

Merit-based Incentive Payment System (MIPS)

Final score

92.2 of 100Reported as group

Quality

100

Improvement activities

40

Cost

73.99

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Desert Ear, Nose & Throat Medical Group, Inc.

  • Otolaryngology Physician
  • Rancho Mirage, CA
  • NPI 1477513745
  Medicare reassignment Care Compare group
• Eisenhower Medical Center

  • General Acute Care Hospital
  • Rancho Mirage, CA
  • NPI 1013981554
  NPD (past)
• Bashar Succar MD PC

  • Hearing Aid Equipment
  • Pontiac, MI
  • NPI 1831298934
  NPD (past)
• Michigan Ear Nose and Throat Associates PC

  • Otolaryngology Physician
  • Pontiac, MI
  • NPI 1073560355
  NPD (past)

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

• Eisenhower Medical Center

  • General Acute Care Hospital
  • Rancho Mirage, CA
  • NPI 1013981554
  Care Compare affiliation

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

{
    "created_epoch": "1124668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435276800000",
    "number": "1376535708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39000 BOB HOPE DR",
            "address_2": "WRIGHT BLDG #301",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922703221",
            "telephone_number": "760-340-4566",
            "fax_number": "760-340-2481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39000 BOB HOPE DR",
            "address_2": "WRIGHT BLDG #301",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922703221",
            "telephone_number": "760-340-4566",
            "fax_number": "760-340-2481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MARK",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-22",
        "last_updated": "2015-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MI",
            "license": "4301063104",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": "C135134",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCAR PTAN",
            "identifier": "CA148759",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PLAN OF MICHIGAN",
            "identifier": "30036",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER ID",
            "identifier": "407001921",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "442264310",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "MW063104",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William S. Longfellow, M.D., Inc.
• Kiyanna Marie Williams, MD
• Alan E. Williamson, M.D.
• George William Wilson, M.D.
• Joseph W Wilson Jr., MD
• Sherry Lee Wilson, PA-C
• McKelle S Wilwand, PA-C
• Deborah Windham, MD
• Carol Annette Wingfield, APRN-CNP
• Nathaniel R Wise, MD

• Otolaryngology Physician in Rancho Mirage, CA
• Providers in Rancho Mirage, CA by specialty
• Otolaryngology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2015; 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.