Jon Daniel Wilson, MD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

4301076903 Issued in MI

Practice address

10810 Executive Center Dr Ste 100
Little Rock, AR 72211-4386

Phone

(501) 604-2695

Fax

(501) 604-2699

NPI assigned

Mar 24, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AR

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

Pathology

Education

University of Hawaii John a. Burns School of Medicine, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Nephropathology Associates, PLCGroup PAC ID 6901707405, 30 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Nephropathology Associates, PLC

  dba Arkana Laboratories

  • Anatomic Pathology Physician
  • Little Rock, AR
  • NPI 1649545195
  Medicare reassignment Care Compare group NPD
• Nephropathology Associates, PLC

  dba Arkana Laboratories

  • Anatomic Pathology Physician
  • Little Rock, AR
  • NPI 1821156035
  NPD (past)
• Louisiana State University Health Sciences Center

  dba LSUHSC-S Department of Pathology

  • Anatomic Pathology & Clinical Pathology Physician
  • Shreveport, LA
  • NPI 1326117003
  NPD (past)
• University of Minnesota Physicians

  • Multi-Specialty Clinic/Center
  • Minneapolis, MN
  • NPI 1477598118
  NPD (past)

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447200000000",
    "number": "1407816218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10810 EXECUTIVE CENTER DR STE 100",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722114386",
            "telephone_number": "501-604-2695",
            "fax_number": "501-604-2699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10810 EXECUTIVE CENTER DR STE 100",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722114386",
            "telephone_number": "501-604-2695",
            "fax_number": "501-604-2699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JON",
        "middle_name": "DANIEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-24",
        "last_updated": "2015-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MI",
            "license": "4301076903",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4244846",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "220F362370",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Noelle Wilson, PSYD
• Jesse E Wilson, MHPP
• Jessica Wilson, ATC, LAT
• Jillian Wilson, FNP-BC, APRN
• John L Wilson, M.D.
• Jonathan Earl Wilson, MHPP
• Kelsey Sueann Wilson, SLP
• Kendall Levell Wilson, DC
• Kim Yung Wilson, OTR
• Kobe Wilson, BA

• Anatomic Pathology & Clinical Pathology Physician in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Anatomic Pathology & Clinical Pathology Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2015; 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.