Active NPI
Gregory J Wilson, DO
- Rheumatology Physician
- State College, PA
National Provider Identifier
1669406799
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rheumatology Physician
- License
- O-0777
- Practice address
- 2505 Green Tech Dr Ste C
State College, PA 16803-2316 - Phone
- (814) 235-0484
- Fax
- (814) 234-7587
- NPI assigned
- Jul 11, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | OS-013257 | PA | |
| Internal Medicine Physician | 207R00000X | 2010015957 | MO | |
| Rheumatology Physician | 207RR0500X | OS013257 | PA | |
| Rheumatology Physician | 207RR0500X | O-0777 | ID | Primary |
Addresses
Primary practice location
2505 Green Tech Dr Ste C
State College, PA 16803-2316
Mailing address
190 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-2222
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669406799 | Medicaid | ID | |
| 101334728 | Medicaid | PA | |
| 1013347280004 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Rheumatology
- Education
- Lake Erie College of Osteopathic Medicine, Erie, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1061 N Front St
2 Mount Nittany Physician Group
Philipsburg, PA 16866-8257
Phone (814) 376-6200
129 Medical Park LN
Bellefonte, PA 16823-9112
Phone (814) 355-3626
141 Medical Park LN
Bellefonte, PA 16823-9112
Phone (814) 355-7322
Hospital & facility affiliations
- Mount Nittany Medical Center
- Penn Highlands Dubois
- Geisinger-Lewistown Hospital
- Upmc Altoona
- Geisinger Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS-013257 | PA | MD | Internal Medicine Physician |
| O-0777 | ID | MD | Rheumatology Physician |
| OS013257 | PA | MD | Rheumatology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Lukes Clinic-Treasure Valley LLC | Internal Medicine | Current | Accepting new patients |
| Mount Nittany Medical Center Health Services Inc | Internal Medicine | Current | Accepting new patients |
| Community Hospitalist of Pennsylvania Inc | Internal Medicine | Past | Accepting new patients |
Locations
190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378
610 W Hays St
Boise, ID 83702
Phone (208) 345-3530
520 S Eagle Rd
Ste 3211
Meridian, ID 83642
Phone (208) 706-5930
141 Medical Park Ln
Bellefonte, PA 16823
Phone (814) 355-7322
1850 E Park Ave
Ste 201
State College, PA 16803
Phone (814) 234-8800
155 Wellness Way
State College, PA 16803
Phone (800) 367-0179
Organizations & group practices 3
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.
-
- Internal Medicine Physician
- State College, PA
- NPI 1598992554
-
- Family Medicine Physician
- Boise, ID
- NPI 1326336058
Internal Medicine
-
- Internal Medicine Physician
- Seneca, PA
- NPI 1992736946
Hospital & facility affiliations 72
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Maternal & Fetal Medicine Physician
- Du Bois, PA
- NPI 1033213608
Hospital
-
- General Acute Care Hospital
- Du Bois, PA
- NPI 1144249657
-
- Endocrinology, Diabetes & Metabolism Physician
- Du Bois, PA
- NPI 1245341387
Hospital
-
- General Acute Care Hospital
- Clearfield, PA
- NPI 1316537228
-
- Cardiovascular Disease Physician
- Punxsutawney, PA
- NPI 1407941305
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686096000000",
"number": "1669406799",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "190 E BANNOCK ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837126241",
"telephone_number": "208-381-2222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2505 GREEN TECH DR STE C",
"city": "STATE COLLEGE",
"state": "PA",
"postal_code": "168032316",
"telephone_number": "814-235-0484",
"fax_number": "814-234-7587"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "GREGORY",
"middle_name": "J",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-11",
"last_updated": "2023-06-07",
"certification_date": "2023-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "PA",
"license": "OS-013257",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MO",
"license": "2010015957",
"primary": false
},
{
"code": "207RR0500X",
"taxonomy_group": "",
"desc": "Internal Medicine, Rheumatology",
"state": "PA",
"license": "OS013257",
"primary": false
},
{
"code": "207RR0500X",
"taxonomy_group": "",
"desc": "Internal Medicine, Rheumatology",
"state": "ID",
"license": "O-0777",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1669406799",
"state": "ID"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "101334728",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1013347280004",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in State College, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.