Reginald Wendell Wilson, M.D.

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

MD 60318390 Issued in WA

Practice address

19505 52ND Ave W
Suite a
Lynnwood, WA 98036-5409

Phone

(206) 623-3814

Fax

(206) 623-4327

NPI assigned

Apr 14, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in AK

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Pathology Consultants Inc.

  • Anatomic Pathology & Clinical Pathology Physician
  • Fairbanks, AK
  • NPI 1316997794
  Medicare reassignment NPD
• Oconee Pathology Associates, P.C.

  • Anatomic Pathology & Clinical Pathology Physician
  • Milledgeville, GA
  • NPI 1881899458
  NPD (past) Authorized official
• Medical Laboratory Associates

  • Clinical Medical Laboratory
  • Lynnwood, WA
  • NPI 1295887610
  NPD (past)
• Interpath Laboratory, Inc.

  • Clinical Medical Laboratory
  • Pendleton, OR
  • NPI 1548208440
  NPD (past)

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

{
    "created_epoch": "1144972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494460800000",
    "number": "1477517563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19505 52ND AVE W",
            "address_2": "SUITE A",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980365409",
            "telephone_number": "206-623-3814",
            "fax_number": "206-623-4327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19505 52ND AVE W",
            "address_2": "SUITE A",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980365409",
            "telephone_number": "206-623-3814",
            "fax_number": "206-623-4327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "REGINALD",
        "middle_name": "WENDELL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-14",
        "last_updated": "2017-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "GA",
            "license": "030927",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "WA",
            "license": "MD 60318390",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000787652A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "10049819",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00256641",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEACH STATE  HLT PLANS",
            "identifier": "118365",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSGA PROVIDER #",
            "identifier": "727301",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "297058",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Wilson, PA-C
• Lindsey L Wilson, LMHC, NCC
• Mark Aaron Wilson, MD
• Michelle Lyn Wilson, LMT
• Pilar Wilson, OTR
• Brandy Lee Wiltermuth, AP
• Victoria Winbow, DPT
• Bonnie J. Witrak, MD
• Adeyababa Fisseha Woldetensaye
• Kaileen Wolf

• Anatomic Pathology & Clinical Pathology Physician in Lynnwood, WA
• Providers in Lynnwood, WA by specialty
• Anatomic Pathology & Clinical Pathology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 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.