NPIMap

Individual provider Active NPI

David B Wilson, M.D.

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Indiana, PA
National Provider Identifier
1386604072
Registry record updated Oct 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
MD065847L Issued in PA
Practice address
120 Irmc Dr
Suite 160
Indiana, PA 15701-3674
Phone
(724) 465-2676
Fax
(724) 349-1830
NPI assigned
Mar 25, 2006
Last updated
Oct 1, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X MD065847L PA Primary

Addresses

Primary practice location

120 Irmc Dr
Suite 160
Indiana, PA 15701-3674

Mailing address

640 Kolter Dr
Indiana, PA 15701-3570
Phone (724) 357-7333

Other identifiers 2

IdentifierTypeStateIssuer
0017454620003MedicaidPA
CI1160OtherPARAILROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040305000713 PA Practitioner - Orthopedic Surgery 0749178325 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
University of Pittsburgh School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ipg Ortho LLPGroup PAC ID 7517472178, 16 clinicians
Keystone Rehabilitation Systems IncGroup PAC ID 7012826753, shared by 15 NPIs, 750 clinicians

Practice addresses (Care Compare)

120 Irmc Dr
Suite 160
Indiana, PA 15701-3675
Phone (724) 465-2676

205 Hampton Ave
Punxsutawney, PA 15767-2133
Phone (814) 938-0148

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.9 of 100Reported as apm
Quality
85.02
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Knee replacement1-10
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD065847LPAMDSports Medicine (Orthopaedic Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Center for Orthopaedic and Sports Medicine PC Sports Medicine CurrentSince May 1, 2005 Accepting new patients
Indiana Healthcare Physician Services Inc CurrentSince Oct 1, 2019 Accepting new patients
Cosm Rehab CurrentSince May 1, 2005 Accepting new patients
Indiana Healthcare Physician Services, Inc CurrentSince Oct 1, 2019 Accepting new patients
Ipg Ortho LLP Sports Medicine CurrentSince Jul 1, 2025 Accepting new patients
Aria Health Physician Services Past Accepting new patients
Mercy Physician Group Sports Medicine Past Accepting new patients
Windber Hospital, Inc. Past Accepting new patients

Locations

25 Colony Blvd
Ste 110
Blairsville, PA 15717
Phone (724) 459-1790

120 Irmc Dr
Ste 160
Indiana, PA 15701
Phone (724) 357-7068

640 Kolter Dr
Indiana, PA 15701
Phone (724) 357-7196

879 Hospital Rd
Indiana, PA 15701
Phone (724) 349-3031

720 W Mahoning St
Punxsutawney, PA 15767
Phone (814) 938-0740

720 W Mahoning St
Ste 200
Punxsutawney, PA 15767
Phone (814) 938-0740

Interoperability endpoints

  • Direct secure messaging: david.wilson.1@10717.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/10717/brand/1/csg/1/fhir/r4

Organizations & group practices 8

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.

Hospital & facility affiliations 33

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

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1143244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569888000000",
    "number": "1386604072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 KOLTER DR",
            "city": "INDIANA",
            "state": "PA",
            "postal_code": "157013570",
            "telephone_number": "724-357-7333",
            "fax_number": "724-465-0193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 IRMC DR",
            "address_2": "SUITE 160",
            "city": "INDIANA",
            "state": "PA",
            "postal_code": "157013674",
            "telephone_number": "724-465-2676",
            "fax_number": "724-349-1830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "DAVID",
        "middle_name": "B",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-25",
        "last_updated": "2019-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "PA",
            "license": "MD065847L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0017454620003",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CI1160",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indiana, PA

Sources for this page

Verify at the official NPI Registry.