Individual provider Active NPI

Robert Leeson Wilson, MD

  • Cardiovascular Disease Physician
  • Appleton, WI
National Provider Identifier
1568413466
Registry record updated Jan 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
26620-020 Issued in WI
Practice address
1818 N Meade St
Appleton, WI 54911-3454
Phone
(920) 731-8900
Fax
(920) 225-1479
NPI assigned
May 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 26620-020 WI
Cardiovascular Disease Physician 207RC0000X 26620-020 WI Primary

Addresses

Primary practice location

1818 N Meade St
Appleton, WI 54911-3454

Mailing address

PO Box 8003
Appleton, WI 54912-8003
Phone (920) 738-4780

Other identifiers 1

IdentifierTypeStateIssuer
30638900MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20050222000586 WI Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 4789597790 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
University of Iowa, RJ & L Carver College of Medicine, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ascension Medical Group-Fox Valley Wisconsin, IncGroup PAC ID 0244142420, shared by 2 NPIs, 260 clinicians

Practice addresses (Care Compare)

1506 S Oneida St
Appleton, WI 54915-1305
Phone (920) 738-2000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
26620-020WIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Calumet Hospital, Inc CurrentSince Sep 7, 2021 Accepting new patients
Ascension Medical Group-Fox Valley Wisconsin, Inc CurrentSince Sep 7, 2021 Accepting new patients
Ascension Medical Group-Fox Valley Wisconsin, Inc Cardiovascular Disease CurrentSince Sep 7, 2021 Accepting new patients
Heart and Vascular of Wisconsin, SC Cardiovascular Disease CurrentSince Mar 1, 2019 Accepting new patients

Locations

5045 W Grande Market Dr
Appleton, WI 54913
Phone (920) 747-0505

1506 S Oneida St
Appleton, WI 54915
Phone (920) 730-4950

1818 N Meade St
Appleton, WI 54911
Phone (920) 731-4101

1501 S Madison St
Appleton, WI 54915
Phone (920) 730-4435

225 Memorial Dr
Berlin, WI 54923
Phone (920) 361-1313

614 Memorial Dr
Chilton, WI 53014
Phone (800) 458-4042

1420 Algoma St
New London, WI 54961
Phone (920) 828-8300

1405 Mill St
New London, WI 54961
Phone (920) 531-2000

2700 W 9th Ave
Oshkosh, WI 54904
Phone (920) 223-0220

Organizations & group practices 4

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": "1147651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296172800000",
    "number": "1568413466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8003",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549128003",
            "telephone_number": "920-738-4780",
            "fax_number": "920-738-5787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 N MEADE ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549113454",
            "telephone_number": "920-731-8900",
            "fax_number": "920-225-1479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "ROBERT",
        "middle_name": "LEESON",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-15",
        "last_updated": "2011-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "26620-020",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "WI",
            "license": "26620-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30638900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.