Individual provider Active NPI

Wilson Fulla Bernales, M.D.

  • Family Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1508824467
Registry record updated Sep 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
14208 Issued in NV
Practice address
2290 E Flamingo Rd Ste F
Las Vegas, NV 89119-0846
Phone
(702) 955-4949
NPI assigned
May 2, 2006
Last updated
Sep 29, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 14208 NV Primary
Adult Medicine Physician 207QA0505X C1-0007844 DE

Addresses

Primary practice location

2290 E Flamingo Rd Ste F
Las Vegas, NV 89119-0846

Mailing address

2290 E Flamingo Rd Ste F
Las Vegas, NV 89119-0846
Phone (702) 955-4949

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20130107000155 NV Practitioner - Family Practice 1153487277 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
C1-0007844DEMDAdult Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Winnebago Indian Health Service Past Accepting new patients
Sound Physicians of Wyoming, LLC Family Medicine Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790640000000",
    "number": "1508824467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2290 E FLAMINGO RD STE F",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891190846",
            "telephone_number": "702-955-4949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2290 E FLAMINGO RD STE F",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891190846",
            "telephone_number": "702-955-4949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERNALES",
        "first_name": "WILSON",
        "middle_name": "FULLA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-02",
        "last_updated": "2026-09-29",
        "certification_date": "2026-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "14208",
            "primary": true
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "DE",
            "license": "C1-0007844",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.