Active NPI
Brian Claud Wilson, MD
- Otolaryngology Physician
- Rock Hill, SC
National Provider Identifier
1669473237
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 15101
- Practice address
- 197 S Herlong Ave
Rock Hill, SC 29732-3427 - Phone
- (803) 366-9000
- Fax
- (803) 366-9200
- NPI assigned
- Aug 9, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 15101 | SC | Primary |
| Otolaryngology Physician | 207Y00000X | 39899 | NC |
Addresses
Primary practice location
197 S Herlong Ave
Rock Hill, SC 29732-3427
Mailing address
197 S Herlong Ave
Rock Hill, SC 29732-3427
Phone (803) 366-9000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 151016 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39899 | NC | MD | Otolaryngology Physician |
Interoperability endpoints
- swelch0716@entandface.providersdirect.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211846400000",
"number": "1669473237",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "197 S HERLONG AVE",
"city": "ROCK HILL",
"state": "SC",
"postal_code": "297323427",
"telephone_number": "803-366-9000",
"fax_number": "803-366-9200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "197 S HERLONG AVE",
"city": "ROCK HILL",
"state": "SC",
"postal_code": "297323427",
"telephone_number": "803-366-9000",
"fax_number": "803-366-9200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "BRIAN",
"middle_name": "CLAUD",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-09",
"last_updated": "2008-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "SC",
"license": "15101",
"primary": true
},
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "NC",
"license": "39899",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "151016",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rock Hill, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.