Individual provider Active NPI

Ronald Shane Wilson, PT

  • Physical Therapist
  • Columbia, TN
National Provider Identifier
1629150941
Registry record updated Oct 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2988 Issued in TN
Practice address
1050 N James M Campbell Blvd Ste 200
Columbia, TN 38401-2754
Phone
(931) 381-2663
Fax
(931) 490-1369
NPI assigned
Oct 19, 2006
Last updated
Oct 12, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2988 TN Primary

Addresses

Primary practice location

1050 N James M Campbell Blvd Ste 200
Columbia, TN 38401-2754

Mailing address

PO Box 306556
Nashville, TN 37230-6556
Phone (865) 243-8153

Other identifiers 1

IdentifierTypeStateIssuer
Q013494MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031217000182 TN Practitioner - Physical Therapist in Private Practice 9931006020 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tennessee Orthopaedic Alliance PAGroup PAC ID 5193625069, 358 clinicians

Practice addresses (Care Compare)

1050 N James M Campbell Blvd
Suite 200
Columbia, TN 38401-2754
Phone (931) 381-2663

8 City Blvd
Suite 100
Nashville, TN 37209-2558
Phone (615) 329-6600

Merit-based Incentive Payment System (MIPS)

Final score
81.78 of 100Reported as group
Quality
65.3
Promoting interoperability
96
Improvement activities
40
Cost
77.31

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2988TNMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Tennessee Orthopaedic Alliance PA CurrentSince Jan 1, 2021 Accepting new patients
Tennessee Orthopaedic Alliance PA CurrentSince Jan 1, 2021 Accepting new patients
Mid-Tennessee Bone & Joint CurrentSince Apr 18, 2013 Accepting new patients
Tennessee Orthopaedic Alliance PA Past Accepting new patients
Southern Physical Therapy, LLC Physical Therapist Past Accepting new patients
Independent Physical Therapy LLC Physical Therapist Past Accepting new patients

Locations

1050 N James M Campbell Blvd
Ste 100
Columbia, TN 38401
Phone (931) 375-1050

1050 N James M Campbell Blvd
Ste 110
Columbia, TN 38401
Phone (931) 381-2663

1050 N James M Campbell Blvd
Ste 200
Columbia, TN 38401
Phone (931) 381-2661

8 City Blvd
Ste 100
Nashville, TN 37209
Phone (615) 263-0155

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: shane.wilsonptatc.p1@direct.mtbj.nextgenshare.com
  • Direct secure messaging: shane.wilsonptatc.p3@direct.toa.nextgenshare.com

Organizations & group practices 6

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": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697068800000",
    "number": "1629150941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 306556",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372306556",
            "telephone_number": "865-243-8153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 N JAMES M CAMPBELL BLVD STE 200",
            "city": "COLUMBIA",
            "state": "TN",
            "postal_code": "384012754",
            "telephone_number": "931-381-2663",
            "fax_number": "931-490-1369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "RONALD",
        "middle_name": "SHANE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "2988",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q013494",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.