NPIMap

Individual provider Active NPI

Jacob Wilson, M.D.

  • Family Medicine Physician
  • Huntsville, AL
National Provider Identifier
1396192423
Registry record updated Jul 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
36564 Issued in AL
Practice address
333 Whitesport Dr SW Ste 204
Huntsville, AL 35801-3455
Phone
(256) 715-5001
NPI assigned
May 18, 2016
Last updated
Jul 1, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 36564 AL Primary

Addresses

Primary practice location

333 Whitesport Dr SW Ste 204
Huntsville, AL 35801-3455

Mailing address

333 Whitesport Dr SW Ste 204
Huntsville, AL 35801-3455
Phone (256) 715-5001

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20181126001040 AL Practitioner - Family Practice 1456605773 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Mississippi School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Pathway Healthcare Alabama LLCGroup PAC ID 1658653548, 7 clinicians

Practice addresses (Care Compare)

48 Medical Park Dr E
Suite 453
Birmingham, AL 35235-3472
Phone (205) 517-7730

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36564ALMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Family Care Inc Family Medicine CurrentSince Dec 17, 2024 Accepting new patients
Pathway Healthcare Alabama LLC CurrentSince Oct 15, 2025 Accepting new patients
Alabama Post-Acute Medical Service 1 PC CurrentSince Mar 24, 2025 Accepting new patients
CS Pacs 3 Southeast, LLC CurrentSince Mar 24, 2025 Accepting new patients
American Family Care, LLC Family Medicine CurrentSince Sep 19, 2018 Accepting new patients
Advantage Family Care, Inc. CurrentSince Dec 17, 2024 Accepting new patients
American Family Care, LLC CurrentSince Sep 19, 2018 Accepting new patients
Signify Health, LLC CurrentSince Jan 29, 2022 Accepting new patients
Diversicare Windsor House, LLC Past Accepting new patients

Locations

1555 Hillabee St
Alexander City, AL 35010
Phone (256) 329-0847

1285 US Highway 72 E
Athens, AL 35611
Phone (256) 278-3004

4000 Eagle Point Corporate Dr
Birmingham, AL 35242
Phone (205) 317-0280

48 Medical Park Dr E
Ste 453
Birmingham, AL 35235
Phone (205) 517-7730

1841 Cherokee Ave SW
Cullman, AL 35055
Phone (256) 297-2548

1115 Beltline Rd SE
Ste 400
Decatur, AL 35601
Phone (256) 898-3004

280 Mt Hebron Rd
Elmore, AL 36025
Phone (334) 265-7585

2131 Military St S
Ste 1
Hamilton, AL 35570
Phone (205) 921-5556

2010 S Point Park Cir
Ste 200
Huntsville, AL 35801
Phone (256) 880-5818

8151 Whitesburg Dr SE
Huntsville, AL 35802
Phone (256) 882-9711

900 Bob Wallace Ave SW
Ste 104
Huntsville, AL 35801
Phone (256) 539-0781

1720 Knowles Rd
Phenix City, AL 36869
Phone (334) 291-0485

857 Crawford Ln
Prichard, AL 36617
Phone (251) 433-9801

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

Organizations & group practices 10

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 3

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": "1463529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593561600000",
    "number": "1396192423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 WHITESPORT DR SW STE 204",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358013455",
            "telephone_number": "256-715-5001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 WHITESPORT DR SW STE 204",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358013455",
            "telephone_number": "256-715-5001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JACOB",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-18",
        "last_updated": "2020-07-01",
        "certification_date": "2020-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "36564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntsville, AL

Sources for this page

Verify at the official NPI Registry.