Active NPI
Jaimin Wilson, PA
- Physician Assistant
- Boston, MA
National Provider Identifier
1679305478
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 200 Nashua St
Boston, MA 02114-1105 - Phone
- (617) 635-1100
- NPI assigned
- Aug 19, 2024
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
200 Nashua St
Boston, MA 02114-1105
Mailing address
22 Water St Apt 1509
Cambridge, MA 02141-1399
Phone (401) 864-1689
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
154 Great Rd
Bedford, MA 01730-2725
Phone (781) 430-8161
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Patriot Urgent Care Professionals, PC | Current | Accepting new patients | |
| Patriot Urgent Care Professionals PC | Current | Accepting new patients | |
| The Commonwealth of Massachusetts | Past | Accepting new patients |
Locations
154 Great Rd
Bedford, MA 01730
Phone (781) 430-8161
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.
-
- Urgent Care Clinic/Center
- Waltham, MA
- NPI 1417205105
-
- Urgent Care Clinic/Center
- Cambridge, MA
- NPI 1245123587
-
- Prison Health Clinic/Center
- Boston, MA
- NPI 1518886175
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1734998400000",
"number": "1679305478",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 WATER ST APT 1509",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021411399",
"telephone_number": "401-864-1689"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 NASHUA ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021141105",
"telephone_number": "617-635-1100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JAIMIN",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-08-19",
"last_updated": "2024-12-24",
"certification_date": "2024-12-24",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2024; 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.