NPIMap

Individual provider Active NPI

Robert Allen Wilson, MD

  • Family Medicine Physician
  • Clinton, NC
National Provider Identifier
1629189279
Registry record updated Jan 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
NC3312 Issued in NC
Practice address
120 Southwood Dr
Clinton, NC 28328-5002
Phone
(910) 592-7981
NPI assigned
Aug 31, 2006
Last updated
Jan 10, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 10, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NC3312 NC Primary

Addresses

Primary practice location

120 Southwood Dr
Clinton, NC 28328-5002

Mailing address

328 NE 48TH St
Oak Island, NC 28465-5305
Phone (919) 593-3402

Other identifiers 2

IdentifierTypeStateIssuer
89128FTMedicaidNC
128FTOtherNCBCBS PROVIDER NUMBER

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
I20050203000319 NC Practitioner - Family PracticePractitioner - Emergency Medicine 6507817863 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
NC3312NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
CS Pacs 3 Southeast, LLC CurrentSince Jan 27, 2025 Accepting new patients
Goshen Medical Center Incorporated CurrentSince Sep 7, 2021 Accepting new patients
Goshen Medical Center Incorporated CurrentSince Sep 7, 2021 Accepting new patients
Goshen Medical Center, Incorporated Current Accepting new patients
North Carolina Emergency Physicians, PLLC Emergency Medicine PastSince Feb 9, 2020 Accepting new patients
Liberty Healthcare Group LLC Past Accepting new patients
Emergency Physician Associates of North Carolina, P.C. Emergency Medicine Past Accepting new patients
Liberty Healthcare Group LLC Past Accepting new patients
Sterling Emergency Services of the Southeast, Inc Emergency Medicine Past Accepting new patients

Locations

120 Southwood Dr
Clinton, NC 28328
Phone (910) 592-7981

444 SW Center St
Faison, NC 28341
Phone (910) 267-0421

707 N Elm St
High Point, NC 27262
Phone (336) 885-0141

204 E Old Highway 74
Monroe, NC 28112
Phone (704) 283-3066

4654 Long Beach Rd SE
Southport, NC 28461
Phone (910) 457-0070

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4
  • Direct secure messaging: robert.wilson.1@20427.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Liberty Healthcare Services of Southwood Nursing Center LLCClinton, NC, CCN 345472 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jun 25, 2025
Dec 3, 2025
Liberty Healthcare Services of Mary Gran Nursing Center, LLCClinton, NC, CCN 345218 Skilled nursing facility Adp of the SNF Feb 8, 2026

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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, 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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736467200000",
    "number": "1629189279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "328 NE 48TH ST",
            "city": "OAK ISLAND",
            "state": "NC",
            "postal_code": "284655305",
            "telephone_number": "919-593-3402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 SOUTHWOOD DR",
            "city": "CLINTON",
            "state": "NC",
            "postal_code": "283285002",
            "telephone_number": "910-592-7981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "ROBERT",
        "middle_name": "ALLEN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2025-01-10",
        "certification_date": "2025-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "NC3312",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89128FT",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "128FT",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton, NC

Sources for this page

Verify at the official NPI Registry.