NPIMap

Individual provider Active NPI

Clint N. Wilson, M.D.

  • Family Medicine Physician
  • Bossier City, LA
National Provider Identifier
1427269059
Registry record updated Dec 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
201780 Issued in LA
Practice address
5341 Airline Dr Ste 130
Bossier City, LA 71111-6710
Phone
(318) 935-1820
Fax
(318) 935-1863
NPI assigned
May 25, 2007
Last updated
Dec 20, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2023

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 201780 LA Primary

Addresses

Primary practice location

5341 Airline Dr Ste 130
Bossier City, LA 71111-6710

Mailing address

5341 Airline Dr Ste 130
Bossier City, LA 71111-6710
Phone (318) 935-1820

Other practice location 1

4910 Airline Dr
Bossier City, LA 71111-6607
Phone (318) 747-2700

Other identifiers 1

IdentifierTypeStateIssuer
1078409MedicaidLA

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.mettles.com/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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
I20090813000736 LA Practitioner - Family Practice 8820142680 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Louisiana State University School of Medicine in Shreveport, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
WKB Family Medicine AssociatesGroup PAC ID 4183777147, 5 clinicians

Practice addresses (Care Compare)

4910 Airline Dr
Bossier City, LA 71111-6607
Phone (318) 747-2700

5341 Airline Dr
Suite 130
Bossier City, LA 71111-6710
Phone (318) 935-1820

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
201780LAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Willow Chute Medical, LLC Family Medicine CurrentSince Dec 18, 2023 Accepting new patients
WKB Family Medicine Associates Family Medicine CurrentSince Aug 1, 2009 Accepting new patients
WK Bossier Pulmonary & Critical Care Clinic PastSince Jul 1, 2007 Accepting new patients
Cypress Point Nursing & Rehabilitation Center, LLC Past Accepting new patients

Locations

2449 Hospital Dr
Ste 420
Bossier City, LA 71111
Phone (318) 212-7839

4910 Airline Dr
Bossier City, LA 71111
Phone (318) 349-3921

5341 Airline Dr
Ste 130
Bossier City, LA 71111
Phone (318) 935-1820

Interoperability endpoints

  • Direct secure messaging: cwilson3@direct.wkhs.com

Organizations & group practices 4

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 8

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": "1180051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703030400000",
    "number": "1427269059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5341 AIRLINE DR STE 130",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711116710",
            "telephone_number": "318-935-1820",
            "fax_number": "318-935-1863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5341 AIRLINE DR STE 130",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711116710",
            "telephone_number": "318-935-1820",
            "fax_number": "318-935-1863"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4910 Airline Dr",
            "address_purpose": "LOCATION",
            "city": "Bossier City",
            "state": "LA",
            "postal_code": "711116607",
            "country_code": "US",
            "telephone_number": "318-747-2700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "CLINT",
        "middle_name": "N.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-25",
        "last_updated": "2023-12-20",
        "certification_date": "2023-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "201780",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1078409",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.mettles.com/",
            "affiliation": "N",
            "endpointDescription": "2.16.840.1.113883.3.6037.1",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "10320 Little Patuxent Pkwy Ste 233-02",
            "city": "Columbia",
            "state": "MD",
            "country_code": "US",
            "postal_code": "210443313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bossier City, LA

Sources for this page

Verify at the official NPI Registry.