Individual provider Active NPI

Robert Marshall Wilson Jr., DO

  • Family Medicine Physician
  • Milford, DE
National Provider Identifier
1487710810
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
C2-0005119 Issued in DE
Practice address
901 Lakeview Ave
Milford, DE 19963-1731
Phone
(302) 422-6677
Fax
(302) 422-9705
NPI assigned
Dec 29, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X C2-0005119 DE Primary

Addresses

Primary practice location

901 Lakeview Ave
Milford, DE 19963-1731

Mailing address

901 Lakeview Ave
Milford, DE 19963-1731
Phone (302) 422-6677

Other identifiers 2

IdentifierTypeStateIssuer
C2-0005119OtherDESTATE LICENSE #
0001177603MedicaidDE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE
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
I20041207001015 DE Practitioner - Family Practice 8820054208 Practice locations: Milford, DE

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

901 Lakeview Ave
Milford, DE 19963-1731
Phone (302) 422-6677

Hospital & facility affiliations

  • Bayada Home Health Care at Bayhealth Home health agency, Dover, DE, CCN 087024
  • Aveanna Home Healthcare Home health agency, Milford, DE, CCN 087039
  • Amedisys Home Health Home health agency, Georgetown, DE, CCN 087034
  • Christianacare Homehealth Home health agency, Camden, DE, CCN 087301
  • Bayhealth Hospital, Sussex Campus Hospital, Milford, DE, CCN 080009
  • Beebe Medical Center Hospital, Lewes, DE, CCN 080007
  • Bayhealth Medical Center, Kent Campus Hospital, Dover, DE, CCN 080004
  • Tidalhealth Nanticoke, Inc. Hospital, Seaford, DE, CCN 080006

Merit-based Incentive Payment System (MIPS)

Final score
26.35 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
87.84

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Hospital & facility affiliations 8

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": "1167350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1487710810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 LAKEVIEW AVE",
            "city": "MILFORD",
            "state": "DE",
            "postal_code": "199631731",
            "telephone_number": "302-422-6677",
            "fax_number": "302-422-9705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 LAKEVIEW AVE",
            "city": "MILFORD",
            "state": "DE",
            "postal_code": "199631731",
            "telephone_number": "302-422-6677",
            "fax_number": "302-422-9705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "ROBERT",
        "middle_name": "MARSHALL",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-29",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "DE",
            "license": "C2-0005119",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE #",
            "identifier": "C2-0005119",
            "state": "DE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0001177603",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milford, DE

Sources for this page

Verify at the official NPI Registry.