Active NPI
John Keddy Wilson, M.D.
- Psychiatry Physician
- Annandale, VA
National Provider Identifier
1679689897
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 0101232930
- Practice address
- 3300 Woodburn Rd
Annandale, VA 22003-1202 - Phone
- (703) 205-9452
- Fax
- (703) 208-0714
- NPI assigned
- Aug 21, 2006
- Last updated
- Feb 13, 2013
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 0101232930 | VA | Primary |
Addresses
Primary practice location
3300 Woodburn Rd
Annandale, VA 22003-1202
Mailing address
3300 Woodburn Rd
Annandale, VA 22003-1202
Phone (703) 205-9452
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
- 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
- Psychiatry
- Education
- Virginia Commonwealth University, School of Medicine, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
8221 Willow Oaks Corporate Dr
Fairfax Falls Church Community Services Boa
Fairfax, VA 22031-4512
Phone (703) 321-7000
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Organizations & group practices 1
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.
-
dba Fairfax-Falls Church Community Services Board
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Fairfax, VA
- NPI 1154356244
DC
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360713600000",
"number": "1679689897",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3300 WOODBURN RD",
"city": "ANNANDALE",
"state": "VA",
"postal_code": "220031202",
"telephone_number": "703-205-9452",
"fax_number": "703-208-0714"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3300 WOODBURN RD",
"city": "ANNANDALE",
"state": "VA",
"postal_code": "220031202",
"telephone_number": "703-205-9452",
"fax_number": "703-208-0714"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JOHN",
"middle_name": "KEDDY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-21",
"last_updated": "2013-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "VA",
"license": "0101232930",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Annandale, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2013; 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.