Individual provider Active NPI

Patricia Anne Wilson, P.A-C

  • Physician Assistant
  • San Jose, CA
National Provider Identifier
1700823580
Registry record updated Oct 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085.006282 Issued in IL
Practice address
225 North Jackson Avenue
San Jose, CA 95116
Phone
(408) 923-7121
NPI assigned
Jun 1, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA15382 CA
Physician Assistant 363A00000X 2885 TN
Physician Assistant 363A00000X 085.006282 IL Primary

Addresses

Primary practice location

225 North Jackson Avenue
San Jose, CA 95116

Mailing address

2100 Powell Street
Ste 920
Emeryville, CA 94608-1803
Phone (510) 350-2777

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160303001614 TN Practitioner - Physician Assistant 5597844233 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physicians' Urgent Care, PLLCGroup PAC ID 9436336047, 20 clinicians

Practice addresses (Care Compare)

155 Covey Dr
Suite 100
Franklin, TN 37067-5602

155 Covey Rd
Suite 100
Franklin, TN 37067
Phone (615) 472-1550

5021 Hughes Xing
Suite 165
Franklin, TN 37064-1737
Phone (615) 794-8877

700 Old Hickory Blvd
Brentwood, TN 37027-5462
Phone (615) 457-3864

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA15382CAMDPhysician Assistant
085.006282ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Physicians' Urgent Care, PLLC CurrentSince Nov 1, 2020 Accepting new patients

Locations

155 Covey Dr
Ste 100
Franklin, TN 37067
Phone (615) 472-1550

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508371200000",
    "number": "1700823580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 POWELL STREET",
            "address_2": "STE 920",
            "city": "EMERYVILLE",
            "state": "CA",
            "postal_code": "946081803",
            "telephone_number": "510-350-2777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 NORTH JACKSON AVENUE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "95116",
            "telephone_number": "408-923-7121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "PATRICIA",
        "middle_name": "ANNE",
        "credential": "P.A-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-01",
        "last_updated": "2017-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA15382",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "2885",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.006282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.