Jeanette Elizabeth Wilson, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301108210 Issued in MI

Practice address

21099 Masonic Blvd
Saint Clair Shores, MI 48082

Phone

(586) 296-6213

NPI assigned

Jul 2, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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

Family Practice

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Henry Ford Health St. John HospitalGroup PAC ID 3173424082, 332 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Henry Ford Health St John Hospital Hospital, Detroit, MI, CCN 230165
• Henry Ford Health Hospital Hospital, Detroit, MI, CCN 230053

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/mQjCqHb5rkr1u1foU4dqhQPBpi7Qk9R4/
• Direct secure messaging: jwilson1157870@direct.hfhs.org

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.

• Henry Ford Health St. John Hospital

  • Podiatrist
  • Harrison Township, MI
  • NPI 1043478910
  Medicare reassignment Care Compare group NPD
• Henry Ford Cornerstone Medical Group

  • Family Medicine Physician
  • Clinton Township, MI
  • NPI 1851765374
  NPD
• Henry Ford Health St. John Hospital

  • Multi-Specialty Clinic/Center
  • Detroit, MI
  • NPI 1457663197

  Family Medicine

  NPD
• Henry Ford Health St. John Hospital

  • Internal Medicine Physician
  • Detroit, MI
  • NPI 1912965088

  Family Medicine

  NPD
• Henry Ford Health St. John Hospital

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1023088168
  NPD
• St. John Hospital

  • General Acute Care Hospital
  • Detroit, MI
  • NPI 1649355918
  NPD (past)

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

• Henry Ford Health System

  • General Acute Care Hospital
  • Detroit, MI
  • NPI 1134144801
  Care Compare affiliation
• Henry Ford Health St. John Hospital

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1023088168
  Care Compare affiliation

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

{
    "created_epoch": "1435795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529971200000",
    "number": "1376926865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21099 MASONIC BLVD",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480821045",
            "telephone_number": "586-777-2050",
            "fax_number": "586-296-6213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21099 MASONIC BLVD",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "48082",
            "telephone_number": "586-296-6213"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "24911 Little Mack Ave",
            "address_2": "Suite C",
            "address_purpose": "LOCATION",
            "city": "Saint Clair Shores",
            "state": "MI",
            "postal_code": "480803200",
            "country_code": "US",
            "telephone_number": "586-777-2050",
            "fax_number": "586-777-2189",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JEANETTE",
        "middle_name": "ELIZABETH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-02",
        "last_updated": "2018-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301108210",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "4301108210",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Acacia Williams
• Andrea Williams, PA-C
• Jeffrey L Williams, MD
• Patrice Williams, COTA/L
• Braniyla Willis
• Stephen Wilson, MD
• Kala Winckler, M.A. CCC-SLP
• Kynette Windham
• Chelsea Winstrand
• Elizabeth Ann Winterholler, M.A, L.L.P.

• Family Medicine Physician in Saint Clair Shores, MI
• Providers in Saint Clair Shores, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2018; 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.