Robert Borden Wilson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

306374 Issued in LA

Practice address

2300 Hospital Dr Ste 120
Bossier City, LA 71111-2193

Phone

(318) 212-7982

Fax

(318) 212-7989

NPI assigned

Apr 2, 2014

Sex

Male

Sole proprietor

No

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 LA

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

Interoperability endpoints

• Direct secure messaging: rwilson413316@christushealth.direct-ci.net

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.

• WK Preferred Pediatrics

  • Pediatrics Physician
  • Bossier City, LA
  • NPI 1760043491
  Medicare reassignment
• Children's Clinic of Southwest Louisiana, Inc.

  • Pediatrics Physician
  • Lake Charles, LA
  • NPI 1548287584
  NPD (past)
• Christus Health Southwestern Louisiana

  dba Christus Ochsner Lake Area Hospital

  • General Acute Care Hospital
  • Lake Charles, LA
  • NPI 1548796378
  NPD (past)
• Southwest Louisiana Hospital Association Inc

  dba Lake Charles Memorial Hospital

  • General Acute Care Hospital
  • Lake Charles, LA
  • NPI 1972549855
  NPD (past)
• Swla Neonatology

  • Neonatal-Perinatal Medicine Physician
  • Lake Charles, LA
  • NPI 1962174342
  NPD (past)

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

{
    "created_epoch": "1396396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563235200000",
    "number": "1477971885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 LOUISIANA AVE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711013910",
            "telephone_number": "318-212-8951",
            "fax_number": "318-212-6752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 HOSPITAL DR STE 120",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711112193",
            "telephone_number": "318-212-7982",
            "fax_number": "318-212-7989"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6431 Fannin St",
            "address_2": "Suite MSB 3.151",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770301501",
            "country_code": "US",
            "telephone_number": "713-500-5800",
            "fax_number": "713-500-5805",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "ROBERT",
        "middle_name": "BORDEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-02",
        "last_updated": "2019-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "306374",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2449508",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Clint N. Wilson, M.D.
• Dorothy Wilson
• Jeannie Wilson
• Michael Wilson
• Monica Wilson
• Cheryl D. Winborne, SLP
• Winn Community Health Center, Inc. (Bossier Community Health Center Pharmacy)
• Winn Community Health Center, Inc. (Bossier Community Health Center)
• Lauryn Winn
• Jacqueline Yvette Winston

• Pediatrics Physician in Bossier City, LA
• Providers in Bossier City, LA by specialty
• Pediatrics Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2019; 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.