Jake Wilson

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

A141468 Issued in CA

Practice address

1600 W Avenue J
Lancaster, CA 93534

Phone

(661) 949-5000

NPI assigned

Mar 25, 2014

Last updated

Mar 21, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA, TX, WA3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 3

Specialty

Emergency Medicine

Education

University of Texas Medical Branch at Galveston, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Western Washington Emergency Physicians PLLCGroup PAC ID 0749514735, 78 clinicians

Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Pacific County Hospital District 2Group PAC ID 8224939301, 31 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Multicare Good Samaritan Hospital Hospital, Puyallup, WA, CCN 500079
• Willapa Harbor Hospital Hospital, South Bend, WA, CCN 501303
• San Carlos Apache Healthcare Corporation Hospital, Peridot, AZ, CCN 031320

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Pacific County Hospital District 2

  dba Willapa Harbor Hospital

  • Critical Access Hospital
  • South Bend, WA
  • NPI 1295708683
  Medicare reassignment Care Compare group NPD
• Providence Medical Foundation

  • Family Medicine Physician
  • Brea, CA
  • NPI 1871607762
  Medicare reassignment Care Compare group NPD (past)
• Western Washington Emergency Physicians PLLC

  • Emergency Medicine Physician
  • Parkland, WA
  • NPI 1801352505
  Medicare reassignment Care Compare group
• Huntington Park Emergency Physicians, Inc

  • Emergency Medicine Physician
  • Huntington Park, CA
  • NPI 1053747121
  Medicare reassignment NPD
• Montclair Emergency Medical Associates

  • Emergency Medicine Physician
  • Montclair, CA
  • NPI 1316044696
  Medicare reassignment NPD
• San Dimas Emergency Medical Associates Inc.

  • Emergency Medicine Physician
  • San Dimas, CA
  • NPI 1720239460
  Medicare reassignment NPD
• San Carlos Apache Healthcare Corporation

  • Critical Access Hospital Clinic/Center
  • Peridot, AZ
  • NPI 1265813075

  TX

  Medicare reassignment NPD
• Sound Physicians Emergency Medicine of Washington PLLC

  • Emergency Medicine Physician
  • Sedro Woolley, WA
  • NPI 1629532064
  Medicare reassignment NPD
• Providence Medical Foundation

  • Obstetrics & Gynecology Physician
  • Napa, CA
  • NPI 1205131950
  NPD
• Providence Medical Foundation

  • General Practice Physician
  • Diamond Bar, CA
  • NPI 1285890624
  NPD
• Providence Medical Foundation

  • Family Medicine Physician
  • Anaheim, CA
  • NPI 1639715709
  NPD
• Pacific County Hospital District 2

  dba Willapa Medical Clinic

  • Rural Health Clinic/Center
  • South Bend, WA
  • NPI 1760582522
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Multicare Health System

  dba MultiCare Good Samaritan Hospital

  • General Acute Care Hospital
  • Puyallup, WA
  • NPI 1841231461
  Care Compare affiliation
• Pacific County Hospital District 2

  dba Willapa Harbor Hospital

  • Critical Access Hospital
  • South Bend, WA
  • NPI 1295708683
  Care Compare affiliation
• San Carlos Apache Healthcare Corporation

  • Critical Access Hospital Clinic/Center
  • Peridot, AZ
  • NPI 1265813075
  Care Compare affiliation
• San Carlos Apache Healthcare Corporation

  dba Clarence Wesley Health Center

  • Clinic/Center
  • Bylas, AZ
  • NPI 1417330713

  Hospital

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1395705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679356800000",
    "number": "1700203023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1128 OCEAN PARK BLVD APT 201",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904054765",
            "telephone_number": "512-470-6262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W AVENUE J",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "93534",
            "telephone_number": "661-949-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "924 Westwood Blvd",
            "address_2": "Suite 300",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "90024",
            "country_code": "US",
            "telephone_number": "310-794-0585",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JAKE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-03-25",
        "last_updated": "2023-03-21",
        "certification_date": "2023-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WA",
            "license": "MD61413870",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A141468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "13652 Cantara St",
            "city": "Panorama City",
            "state": "CA",
            "country_code": "US",
            "postal_code": "914025423",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Amy Michelle Wilson, NP
• Antwain Wilson
• Christian Wilson
• Darah Lynn Wilson, FNP
• Ebony Wilson, LCSW
• Jamie Wilson
• Julian Jerome Wilson, DDS, FACS
• Kendra Mercedes Wilson
• Peter Wilson
• Valerie Joyce Wilson

• Emergency Medicine Physician in Lancaster, CA
• Providers in Lancaster, CA by specialty
• Emergency Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 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.

Verify at the official NPI Registry.