Active NPI
Russell L. Wilson, M.D.
- Diagnostic Radiology Physician
- Ames, IA
National Provider Identifier
1487636627
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 23024
- Practice address
- 1215 Duff Ave
Ames, IA 50010-3014 - Phone
- (515) 239-4456
- Fax
- (515) 239-4761
- NPI assigned
- Nov 15, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 23024 | IA | Primary |
Addresses
Primary practice location
1215 Duff Ave
Ames, IA 50010-3014
Mailing address
1215 Duff Ave
Ames, IA 50010-3014
Phone (515) 239-4456
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0196311 | Medicaid | IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23024 | IA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347408000000",
"number": "1487636627",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1215 DUFF AVE",
"city": "AMES",
"state": "IA",
"postal_code": "500103014",
"telephone_number": "515-239-4456",
"fax_number": "515-239-4761"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1215 DUFF AVE",
"city": "AMES",
"state": "IA",
"postal_code": "500103014",
"telephone_number": "515-239-4456",
"fax_number": "515-239-4761"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "RUSSELL",
"middle_name": "L.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-15",
"last_updated": "2012-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "IA",
"license": "23024",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0196311",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ames, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.