Active NPI
Karmen Wilson, NP
- Nurse Practitioner
- Fort Wayne, IN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 71009795A
- Practice address
- 1721 Magnavox Way
Fort Wayne, IN 46804-1537 - Phone
- (260) 748-3650
- NPI assigned
- Oct 14, 2019
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 28202168A | IN | |
| Nurse Practitioner | 363L00000X | 71009795A | IN | Primary |
Addresses
Primary practice location
1721 Magnavox Way
Fort Wayne, IN 46804-1537
Mailing address
1721 Magnavox Way
Fort Wayne, IN 46804-1537
Phone (260) 748-3650
Other practice location 1
10475 Crosspoint Blvd Ste 250
Indianapolis, IN 46256-3387
Phone (866) 949-0108
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- 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
- Nurse Practitioner
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
7900 W Jefferson Blvd
Suite 202
Fort Wayne, IN 46804-4128
Phone (260) 435-4730
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28202168A | IN | MD | Registered Nurse |
| 71009795A | IN | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lutheran Medical Group LLC | Current | Accepting new patients | |
| Lutheran Medical Group LLC | Nurse Practitioner | Current | Accepting new patients |
| Global Wound Care Medical Group | Current | Accepting new patients |
Locations
5901 W Century Blvd
Ste 750
Los Angeles, CA 90045
Phone (323) 843-2861
6920 Pointe Inverness Way
Ste 200
Fort Wayne, IN 46804
Phone (260) 479-3514
7900 W Jefferson Blvd
Ste 202
Fort Wayne, IN 46804
Phone (260) 424-9000
2516 E DuPont Rd
Fort Wayne, IN 46825
Phone (260) 434-6076
333 N Alabama St
Ste 350
Indianapolis, IN 46204
Phone (317) 983-0002
Interoperability endpoints
- ms_kwils232@landmarkhealth-direct.org
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.
-
- Cardiovascular Disease Physician
- Fort Wayne, IN
- NPI 1164662805
Nurse Practitioner
-
- Durable Medical Equipment & Medical Supplies
- Fort Wayne, IN
- NPI 1710275664
-
- General Practice Physician
- Los Angeles, CA
- NPI 1235831132
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Fort Wayne, IN
- NPI 1306897335
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1571011200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1639612800000",
"number": "1689216442",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1721 MAGNAVOX WAY",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468041537",
"telephone_number": "260-748-3650"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1721 MAGNAVOX WAY",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468041537",
"telephone_number": "260-748-3650"
}
],
"practiceLocations": [
{
"address_1": "10475 Crosspoint Blvd Ste 250",
"address_purpose": "LOCATION",
"city": "Indianapolis",
"state": "IN",
"postal_code": "462563387",
"country_code": "US",
"telephone_number": "866-949-0108",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILSON",
"first_name": "KARMEN",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-10-14",
"last_updated": "2021-12-16",
"certification_date": "2021-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "IN",
"license": "28202168A",
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IN",
"license": "71009795A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2021; 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.