Individual provider Active NPI

Christine B Wilson, DO

  • Pediatrics Physician
  • Norwich, NY
National Provider Identifier
1407931975
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
177130 Issued in NY
Practice address
4 Newton Ave
Norwich, NY 13815-1153
Phone
(607) 337-4139
NPI assigned
Oct 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 177130 NY Primary

Addresses

Primary practice location

4 Newton Ave
Norwich, NY 13815-1153

Mailing address

PO Box 211
So Plymouth, NY 13844-0211
Phone (607) 334-7825

Other identifiers 1

IdentifierTypeStateIssuer
01286891MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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

Enrollment IDStateProvider typePAC IDDetails
I20050223000710 NY Practitioner - Pediatric Medicine 0941253553 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
177130NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Chenango Memorial Hospital, Inc. Pediatrics CurrentSince Feb 10, 2018 Accepting new patients
Chenango Memorial Hospital Inc Current Accepting new patients
Chenango Memorial Hospital Inc CurrentSince Feb 10, 2018 Accepting new patients

Locations

179 N Broad St
Norwich, NY 13815
Phone (607) 337-4111

4 Newton Ave
Norwich, NY 13815
Phone (607) 337-4034

21 N Canal St
Oxford, NY 13830
Phone (607) 843-9816

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407931975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 211",
            "city": "SO PLYMOUTH",
            "state": "NY",
            "postal_code": "138440211",
            "telephone_number": "607-334-7825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 NEWTON AVE",
            "city": "NORWICH",
            "state": "NY",
            "postal_code": "138151153",
            "telephone_number": "607-337-4139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "CHRISTINE",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "177130",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01286891",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norwich, NY

Sources for this page

Verify at the official NPI Registry.