G Jason Wilks DPM PC

Primary specialty

PodiatristTaxonomy code 213E00000X

License

DP00318 Issued in OR

Legal business name

G JASON WILKS DPM PC

Practice address

1813 W Harvard Ave Ste 201
Roseburg, OR 97471-2754

Phone

(541) 673-0742

Fax

(541) 673-7553

NPI assigned

Dec 29, 2016

Organization subpart

No

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

Authorized official

Name

G Jason Wilks, DPM

Title

Owner

Phone

(541) 673-0742

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Wilks Advanced Foot Care Doing business as

Medicare fee-for-service enrollment

Enrolled in OR2 enrollments

Enrollment records 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• G Jason Wilks, DPM

  • Podiatrist
  • Roseburg, OR
  • NPI 1316006539
  Medicare reassignment NPD

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

{
    "created_epoch": "1482969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762905600000",
    "number": "1639614647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1813 W HARVARD AVE STE 201",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974712754",
            "telephone_number": "541-673-0742",
            "fax_number": "541-673-7553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1813 W HARVARD AVE STE 201",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974712754",
            "telephone_number": "541-673-0742",
            "fax_number": "541-673-7553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "G JASON WILKS DPM PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-29",
        "last_updated": "2025-11-12",
        "certification_date": "2025-11-12",
        "status": "A",
        "authorized_official_last_name": "WILKS",
        "authorized_official_first_name": "G JASON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-673-0742",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "OR",
            "license": "DP00318",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wilks Advanced Foot Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nancy Marie Fuller, NP
• Aaron Nicholas Fullwiler, LD
• Shelly Robyn Fultz, LPN
• Jacqueline Jill Fummerton, RN
• Kellie Fusco
• Judy Diane Gabehart-Geant, M.ED., L.P.C.
• Jay N Gade, MD PHD
• Frederick Carl Gaestel
• Kelli Renee Gaffield, FNP
• Suzann Adrienne Gage, APNP, WHNP-BC

• Podiatrist in Roseburg, OR
• Providers in Roseburg, OR by specialty
• Podiatrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.