Active NPI
Jacqueline S Wilson, M.D.
- Psychiatry Physician
- Bozeman, MT
National Provider Identifier
1568403640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 8315
- Practice address
- 321 E Main St
Suite 309
Bozeman, MT 59715-6241 - Phone
- (406) 586-7515
- Fax
- (406) 522-0481
- NPI assigned
- Jun 9, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 8315 | MT | Primary |
Addresses
Primary practice location
321 E Main St
Suite 309
Bozeman, MT 59715-6241
Mailing address
321 E Main St
Suite 309
Bozeman, MT 59715-6241
Phone (406) 586-7515
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0152425 | Medicaid | MT | |
| 93296 | Other | MT | BCBS |
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 |
|---|---|---|---|
| 8315 | MT | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jacqueline S. Wilson, M.D., P.C. | Past | Accepting new patients | |
| South Central Montana Regional Mental Health Center | Psychiatry | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Adult Mental Health Clinic/Center
- Bozeman, MT
- NPI 1194822049
-
- Clinic/Center
- Billings, MT
- NPI 1891781787
Psychiatry
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205712000000",
"number": "1568403640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "321 E MAIN ST",
"address_2": "SUITE 309",
"city": "BOZEMAN",
"state": "MT",
"postal_code": "597156241",
"telephone_number": "406-586-7515",
"fax_number": "406-522-0481"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "321 E MAIN ST",
"address_2": "SUITE 309",
"city": "BOZEMAN",
"state": "MT",
"postal_code": "597156241",
"telephone_number": "406-586-7515",
"fax_number": "406-522-0481"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JACQUELINE",
"middle_name": "S",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-06-09",
"last_updated": "2008-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MT",
"license": "8315",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0152425",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "93296",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bozeman, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.