Active NPI
Nathan Jerome Wilson, D.O.
- Family Medicine Physician
- Long Beach, CA
National Provider Identifier
1720053572
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 20A5796
- Practice address
- 4221 Chestnut Ave
Long Beach, CA 90807-1903 - Phone
- (310) 720-0758
- NPI assigned
- Feb 22, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 20A5796 | CA | Primary |
Addresses
Primary practice location
4221 Chestnut Ave
Long Beach, CA 90807-1903
Mailing address
4221 Chestnut Ave
Long Beach, CA 90807-1903
Phone (310) 720-0758
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20A5796 | CA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Healthcare Partners Affiliates Medical Group | Past | Accepting new patients | |
| Healthcare Partners Affiliates Medical Group | Family Medicine | Past | Accepting new patients |
Organizations & group practices 2
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140566400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1423612800000",
"number": "1720053572",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4221 CHESTNUT AVE",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908071903",
"telephone_number": "310-720-0758"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4221 CHESTNUT AVE",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908071903",
"telephone_number": "310-720-0758"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "NATHAN",
"middle_name": "JEROME",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-02-22",
"last_updated": "2015-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "20A5796",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Long Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.