Individual provider Active NPI

Justin Dean Wilson, M.D.

  • Otolaryngology Physician
  • Lone Tree, CO
National Provider Identifier
1467791392
Registry record updated Apr 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
0071454 Issued in CO
Practice address
9980 Park Meadows Dr Ste 200
Lone Tree, CO 80124-8406
Phone
(303) 744-1961
Fax
(303) 744-1154
NPI assigned
Feb 13, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 0071454 CO Primary

Addresses

Primary practice location

9980 Park Meadows Dr Ste 200
Lone Tree, CO 80124-8406

Mailing address

850 E Harvard Ave Ste 505
Denver, CO 80210-5078
Phone (303) 744-1961

Other practice location 1

2352 Meadows Blvd Ste 300
Castle Rock, CO 80109-8419
Phone (303) 744-1961

Other practice location 2

850 E Harvard Ave Ste 505
Denver, CO 80210-5078
Phone (303) 744-1961

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240411003492 CO Practitioner - Otolaryngology 9234509423 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
University of Oklahoma College of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2352 Meadows Blvd
Suite 300
Castle Rock, CO 80109-8419
Phone (303) 607-4134

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.22 of 100Reported as group
Quality
75.39
Promoting interoperability
84
Improvement activities
40
Cost
75.32

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0071454COMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Associates of Otolaryngology, P.C. Current Accepting new patients
Associates of Otolaryngology, P.C. CurrentSince Aug 1, 2024 Accepting new patients
Associates of Otolaryngology, P.C. CurrentSince Aug 1, 2024 Accepting new patients

Locations

2352 Meadows Blvd
Ste 300
Castle Rock, CO 80109
Phone (303) 744-1961

850 E Harvard Ave
Ste 505
Denver, CO 80210
Phone (303) 744-1961

9980 Park Meadows Dr
Ste 200
Lone Tree, CO 80124
Phone (303) 607-4134

Organizations & group practices 3

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.

Hospital & facility affiliations 2

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": "1360713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712102400000",
    "number": "1467791392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 E HARVARD AVE STE 505",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802105078",
            "telephone_number": "303-744-1961",
            "fax_number": "303-744-1154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9980 PARK MEADOWS DR STE 200",
            "city": "LONE TREE",
            "state": "CO",
            "postal_code": "801248406",
            "telephone_number": "303-744-1961",
            "fax_number": "303-744-1154"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2352 Meadows Blvd Ste 300",
            "address_purpose": "LOCATION",
            "city": "Castle Rock",
            "state": "CO",
            "postal_code": "801098419",
            "country_code": "US",
            "telephone_number": "303-744-1961",
            "fax_number": "303-744-1154",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "850 E Harvard Ave Ste 505",
            "address_purpose": "LOCATION",
            "city": "Denver",
            "state": "CO",
            "postal_code": "802105078",
            "country_code": "US",
            "telephone_number": "303-744-1961",
            "fax_number": "303-744-1154",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JUSTIN",
        "middle_name": "DEAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-02-13",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "CO",
            "license": "0071454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lone Tree, CO

Sources for this page

Verify at the official NPI Registry.