Shane David Wilson, AGACNP-BC

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

63040 Issued in WV

Practice address

1249 15TH St Ste 4000
Huntington, WV 25701-3663

Phone

(304) 766-3600

NPI assigned

Oct 8, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WV

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, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Monongalia County General Hospital CompanyGroup PAC ID 9638073380, 241 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mon Health Medical Center Hospital, Morgantown, WV, CCN 510024

Merit-based Incentive Payment System (MIPS)

Final score

90.94 of 100Reported as apm

Quality

69.71

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

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.

• Monongalia County General Hospital Company

  • Specialist
  • Morgantown, WV
  • NPI 1447673223
  Medicare reassignment Care Compare group NPD

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

• Monongalia County General Hospital Company

  • Specialist
  • Morgantown, WV
  • NPI 1447673223

  Hospital

  Care Compare affiliation
• Monongalia County General Hospital Company

  • General Acute Care Hospital
  • Morgantown, WV
  • NPI 1659489631
  Care Compare affiliation

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

{
    "created_epoch": "1538956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604016000000",
    "number": "1437624236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 PARKSTONE DR",
            "city": "FRAZIERS BOTTOM",
            "state": "WV",
            "postal_code": "250826977",
            "telephone_number": "304-382-1090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1249 15TH ST STE 4000",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257013663",
            "telephone_number": "304-766-3600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 J D Anderson Dr",
            "address_purpose": "LOCATION",
            "city": "Morgantown",
            "state": "WV",
            "postal_code": "265053494",
            "country_code": "US",
            "telephone_number": "304-598-1330",
            "fax_number": "304-598-1609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "SHANE",
        "middle_name": "DAVID",
        "credential": "AGACNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-10-08",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "WV",
            "license": "63040",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "WV",
            "license": "63040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew C Wilson, MD
• Megan Wilson, NP
• Nicole D Wilson, LPC, LSW
• Penny Wilson
• Scott Wilson
• Shauna Marie Wilson, LMT, AAS
• Stephen Lawrence Wilson, MD
• Tiffany Wilson
• Joqwan Windham
• Justin Ronald Wine

• Acute Care Nurse Practitioner in Huntington, WV
• Providers in Huntington, WV by specialty
• Acute Care Nurse Practitioner in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 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.