Active NPI
Jeffrey Whiteside Wilson, MD
- Psychiatry Physician
- West Allis, WI
National Provider Identifier
1417065715
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 15620
- Practice address
- 10229 W Greenfield Ave
West Allis, WI 53214 - Phone
- (414) 453-6330
- Fax
- (414) 453-6523
- NPI assigned
- Aug 27, 2006
- Last updated
- Aug 17, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 15620 | WI | Primary |
Addresses
Primary practice location
10229 W Greenfield Ave
West Allis, WI 53214
Mailing address
10229 W Greenfield Ave
West Allis, WI 53214
Phone (414) 453-6330
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11713 | Other | AMER BOARD OF PSYCH NEURO | |
| 31772200 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Adult & Adolescent TRT. Ctr. | Psychiatry | Past | Accepting new patients |
| Thousand Mile Journey LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
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- Glendale, WI
- NPI 1124286430
-
- Family Nurse Practitioner
- Milwaukee, WI
- NPI 1699159962
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156636800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282003200000",
"number": "1417065715",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10229 W GREENFIELD AVE",
"city": "WEST ALLIS",
"state": "WI",
"postal_code": "53214",
"telephone_number": "414-453-6330",
"fax_number": "414-453-6523"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10229 W GREENFIELD AVE",
"city": "WEST ALLIS",
"state": "WI",
"postal_code": "53214",
"telephone_number": "414-453-6330",
"fax_number": "414-453-6523"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JEFFREY",
"middle_name": "WHITESIDE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-27",
"last_updated": "2010-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "WI",
"license": "15620",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMER BOARD OF PSYCH NEURO",
"identifier": "11713",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "31772200",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Allis, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.