Mary Jane Lim Wilson, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

22483 Issued in CA

Practice address

1705 Aspen Village Way
West Covina, CA 91791-3105

Phone

(626) 918-3042

NPI assigned

Apr 17, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Emanate Health Medical Care FoundationGroup PAC ID 9830544980, 85 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Emanate Health Inter-Community Hospital Hospital, Covina, CA, CCN 050382
• Emanate Health Foothill Presbyterian Hospital Hospital, Glendora, CA, CCN 050597

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Emanate Health Medical Care Foundation

  • Multi-Specialty Clinic/Center
  • West Covina, CA
  • NPI 1467195073
  Medicare reassignment Care Compare group NPD
• Healthcare Partners Affiliates Medical Group

  dba Optum

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1659312593
  Medicare reassignment NPD
• Healthcare Partners Affiliates Medical Group

  dba Optum

  • Durable Medical Equipment & Medical Supplies
  • Murrieta, CA
  • NPI 1760057269
  NPD
• Healthcare Partners Affiliates Medical Group

  dba Optum

  • Addiction Medicine (Internal Medicine) Physician
  • Tustin, CA
  • NPI 1891981502
  NPD
• Emanate Health Medical Group

  • General Practice Physician
  • Covina, CA
  • NPI 1881054997
  NPD (past)

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

• Emanate Health Foothill Presbyterian Hospital

  dba Foothill Presbyterian Hospital

  • General Acute Care Hospital
  • Glendora, CA
  • NPI 1992733513
  Care Compare affiliation
• Emanate Health Medical Center

  dba Citrus Valley Medical Center Queen Of the Valley Campus

  • General Acute Care Hospital
  • West Covina, CA
  • NPI 1063441293
  Care Compare affiliation
• Emanate Health Medical Center

  dba Emanate Health Inter-Community Hospital

  • Psychiatric Hospital Unit
  • Covina, CA
  • NPI 1215063151
  Care Compare affiliation
• Emanate Health Medical Center

  dba Citrus Valley Medical Center Inter-Community Campus

  • General Acute Care Hospital
  • Covina, CA
  • NPI 1982629440
  Care Compare affiliation

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

{
    "created_epoch": "1366156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378944000000",
    "number": "1467896753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 ASPEN VILLAGE WAY",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917913105",
            "telephone_number": "626-918-3042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 ASPEN VILLAGE WAY",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917913105",
            "telephone_number": "626-918-3042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MARY JANE",
        "middle_name": "LIM",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-04-17",
        "last_updated": "2013-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "22483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cayla Williams
• William Tenere Williams, MD
• Adelaide Willis, MD
• Wilshire Oncology Medical Group, Inc.
• Wilshire Oncology Medical Group, Inc.
• Sone-Seere A Wilson, MD
• Samuel Winkler
• Christopher Emmanuel Wissar Sr., MD
• Carol Wolcott, PA-C
• Timothy J Wolf, C.R.N.A.08/

• Family Nurse Practitioner in West Covina, CA
• Providers in West Covina, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2013; 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.