Individual provider Active NPI

Ayana Maia Wilson, MD

  • Emergency Medicine Physician
  • Columbia, SC
National Provider Identifier
1376839316
Registry record updated Jun 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
2017-00631 Issued in NC
Practice address
2 Medical Park
Ste. 208 OB/GYN -
Columbia, SC 29203
Phone
(803) 779-4928
Fax
(803) 434-4699
NPI assigned
Jun 28, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 2017-00631 NC Primary

Addresses

Primary practice location

2 Medical Park
Ste. 208 OB/GYN -
Columbia, SC 29203

Mailing address

4535 Dressler Rd NW
Canton, OH 44718
Phone (757) 513-8844

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, NC2 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
I20140130001553 SC Practitioner - Emergency MedicinePractitioner - Obstetrics/Gynecology 6507095106 Reassigns benefits to 1 organization
I20170719001651 NC Practitioner - Emergency Medicine 6507095106 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Michigan State University College of Human Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gastonia Physician Services PLLCGroup PAC ID 3870719602, 66 clinicians

Practice addresses (Care Compare)

2525 Court Dr
Gastonia, NC 28054-2140
Phone (704) 834-2000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.82 of 100Reported as group
Quality
84.07
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2017-00631NCMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gastonia Physician Services, PLLC Emergency Medicine CurrentSince Jul 11, 2018 Accepting new patients
Gastonia Physician Services, PLLC Emergency Medicine CurrentSince Jul 11, 2018 Accepting new patients
Gastonia Physician Services, PLLC Emergency Medicine Current Accepting new patients
Emergency Coverage, LLC Emergency Medicine CurrentSince Apr 1, 2018 Accepting new patients
University Specialty Clinics - Obstetrics/Gynecology PastSince Jan 16, 2008 Accepting new patients

Locations

2525 Court Dr
Gastonia, NC 28054
Phone (704) 834-2662

615 Ridge Rd
Roxboro, NC 27573
Phone (336) 503-5699

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

Organizations & group practices 6

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 1

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

NPI Registry JSON

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

{
    "created_epoch": "1309219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1497830400000",
    "number": "1376839316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4535 DRESSLER RD NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "44718",
            "telephone_number": "757-513-8844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 MEDICAL PARK",
            "address_2": "STE. 208 OB/GYN -",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29203",
            "telephone_number": "803-779-4928",
            "fax_number": "803-434-4699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "AYANA",
        "middle_name": "MAIA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-28",
        "last_updated": "2017-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "2017-00631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.