NPIMap

Individual provider Active NPI

Courtney Elizabeth Wilson, PA

  • Physician Assistant
  • Greenville, NC
National Provider Identifier
1558948638
Registry record updated Jul 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-11921 Issued in NC
Practice address
2756 W Arlington Blvd Apt 302
Greenville, NC 27834-4075
Phone
(224) 944-7794
NPI assigned
Mar 25, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-11921 NC Primary

Addresses

Primary practice location

2756 W Arlington Blvd Apt 302
Greenville, NC 27834-4075

Mailing address

2756 W Arlington Blvd Apt 302
Greenville, NC 27834-4075
Phone (224) 944-7794

Other practice location 1

310 S Stratford Rd
Winston Salem, NC 27103-1820
Phone (336) 714-5399

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220209002804 NC Practitioner - Physician Assistant 7618360942 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
89.09 of 100Reported as group
Quality
84.49
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
86.5 of 100Reported as group
Quality
84.11
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
91.82 of 100Reported as group
Quality
84.07
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
92.02 of 100Reported as group
Quality
82.48
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
74.09 of 100Reported as group
Quality
65.78
Improvement activities
40
Cost
76.37

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-11921NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Gastonia Physician Services, PLLC CurrentSince Jan 20, 2022 Accepting new patients
Urgent Cares of America North Carolina Inc. Past Accepting new patients
Fastmed Primary Care, P.C. Past Accepting new patients

Locations

2525 Court Dr
Gastonia, NC 28054
Phone (704) 834-2662

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1616630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688688000000",
    "number": "1558948638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2756 W ARLINGTON BLVD APT 302",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278344075",
            "telephone_number": "224-944-7794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2756 W ARLINGTON BLVD APT 302",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278344075",
            "telephone_number": "224-944-7794"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "310 S Stratford Rd",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271031820",
            "country_code": "US",
            "telephone_number": "336-714-5399",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "COURTNEY",
        "middle_name": "ELIZABETH",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-25",
        "last_updated": "2023-07-07",
        "certification_date": "2023-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-11921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, NC

Sources for this page

Verify at the official NPI Registry.