Michael John Wilson, PH.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

071.009991 Issued in IL

Practice address

4747 W Peterson Ave Ste 303
Chicago, IL 60646-5748

Phone

(773) 606-4303

NPI assigned

Jun 11, 2019

Last updated

Aug 6, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Chicago Neurobehavior Specialists

  • Clinical Psychologist
  • Orland Park, IL
  • NPI 1780936856
  Medicare reassignment NPD
• Windy City Neuropsychology LLC

  • Clinical Neuropsychologist
  • Chicago, IL
  • NPI 1023855616
  Medicare reassignment NPD

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

{
    "created_epoch": "1560211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722902400000",
    "number": "1386203537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4747 W PETERSON AVE STE 303",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606465748",
            "telephone_number": "773-606-4303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4747 W PETERSON AVE STE 303",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606465748",
            "telephone_number": "773-606-4303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MICHAEL",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-11",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "IL",
            "license": "071.009991",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marquess Tarrill Wilson, M.D.
• Mary Wilson, O.T.
• Megan Erika Wilson, DNP
• Melody Wilson
• Michael C. Wilson
• Michael N Wilson
• Michelle Marie Wilson, OTR/L
• Nakii Valeeta Wilson, OTR
• Nicholas Wilson
• Nichole K Wilson

• Clinical Neuropsychologist in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Neuropsychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2024; 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.