Clemente Wilson, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9100865 Issued in FL

Practice address

900 W 49TH St Ste 308
Hialeah, FL 33012-3435

Phone

(305) 266-2929

Fax

(305) 558-9039

NPI assigned

May 12, 2006

Last updated

Nov 27, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Johnson Medical Services Corporation

  • Family Medicine Physician
  • Lake Worth, FL
  • NPI 1285871665
  Medicare reassignment
• Acevedo Medical Care Group Inc

  • General Practice Physician
  • Miami, FL
  • NPI 1588756001
  NPD (past)

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511740800000",
    "number": "1467403956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8750 NW 36TH ST STE 300",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "331782499",
            "telephone_number": "305-262-1610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 W 49TH ST STE 308",
            "city": "HIALEAH",
            "state": "FL",
            "postal_code": "330123435",
            "telephone_number": "305-266-2929",
            "fax_number": "305-558-9039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "CLEMENTE",
        "name_prefix": "Dr.",
        "credential": "P.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2017-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9100865",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN ASSISTANT",
            "identifier": "PA9100865",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paula Carlin Williams, PA-C
• Roan Williams, M.D.
• Rolinda Williams
• Seantrell Williams
• Willow Psychiatry and Wellness
• Mahara Montano Wilson
• Wind River Medical Group Inc.
• Ina Winderman, R.P.T.
• Windmills Mental Health Services LLC
• Wise of Life Inc

• Physician Assistant in Hialeah, FL
• Providers in Hialeah, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.