Gloria J Wilson, CNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

COA12816NP Issued in OH

Practice address

5964 Golf Club LN
Fairfield Township, OH 45011-8224

Phone

(513) 893-1100

Fax

(513) 893-1128

NPI assigned

Jan 23, 2012

Sex

Female

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 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Alliance Physicians IncGroup PAC ID 0840104360, 314 clinicians

Kettering Independent Medical Group IncGroup PAC ID 3173710936, 699 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Fort Hamilton Hughes Memorial Hospital Hospital, Hamilton, OH, CCN 360132

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Master of Science

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 and National Provider Directory roles.

• Alliance Physicians Inc

  dba Kettering Health Medical Group

  • Family Medicine Physician
  • Kettering, OH
  • NPI 1437125572
  Medicare reassignment Care Compare group NPD
• Kettering Independent Medical Group Inc

  • Orthopaedic Surgery Physician
  • Miamisburg, OH
  • NPI 1629387865
  Medicare reassignment Care Compare group NPD
• Alliance Physicians Inc

  dba Kettering Behavioral Medicine Center

  • Psychiatry Physician
  • Moraine, OH
  • NPI 1780852228
  NPD
• Neurology Associates of Southern Ohio LLC

  • Neurology Physician
  • Hamilton, OH
  • NPI 1013168087
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• The Fort Hamilton Hospital

  dba Kettering Health Hamilton

  • General Acute Care Hospital
  • Hamilton, OH
  • NPI 1104867167
  Care Compare affiliation

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

{
    "created_epoch": "1327276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605225600000",
    "number": "1437420452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5964 GOLF CLUB LN",
            "city": "FAIRFIELD TOWNSHIP",
            "state": "OH",
            "postal_code": "450118224",
            "telephone_number": "513-893-1100",
            "fax_number": "513-893-1128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5964 GOLF CLUB LN",
            "city": "FAIRFIELD TOWNSHIP",
            "state": "OH",
            "postal_code": "450118224",
            "telephone_number": "513-893-1100",
            "fax_number": "513-893-1128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "GLORIA",
        "middle_name": "J",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-23",
        "last_updated": "2020-11-13",
        "certification_date": "2020-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "COA12816NP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0060292",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gwilson477212@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "5964 Golf Club Ln",
            "city": "Fairfield Township",
            "state": "OH",
            "country_code": "US",
            "postal_code": "450118224",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://khnarr.ketthealth.com/FHIR-PROD/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "5964 Golf Club Ln",
            "city": "Fairfield Township",
            "state": "OH",
            "country_code": "US",
            "postal_code": "450118224",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Keenath Michael Watkins
• Wellness Docs Corporation
• Rebecca Westerman
• Nathan White
• Matthew W Williamson
• Haedyn Woodson
• Nakiya M Wynn
• Tracy Ann Daffron Yax
• Dominic Atta Yeboah
• Lilith V York

• Family Nurse Practitioner in Fairfield Township, OH
• Providers in Fairfield Township, OH by specialty
• Family Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2020; 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.