Individual provider Active NPI

John David Wilkinson, M.D.

  • Internal Medicine Physician
  • Edmond, OK
National Provider Identifier
1730234501
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
14808 Issued in OK
Practice address
105 S Bryant Ave Ste 101
Edmond, OK 73034-6330
Phone
(405) 622-3063
Fax
(855) 680-8890
NPI assigned
Jan 24, 2007
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 14808 OK Primary

Addresses

Primary practice location

105 S Bryant Ave Ste 101
Edmond, OK 73034-6330

Mailing address

105 S Bryant Ave Ste 101
Edmond, OK 73034-6330
Phone (405) 622-3063

Other identifiers 1

IdentifierTypeStateIssuer
33487OtherGASTATE MEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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 1

Enrollment IDStateProvider typePAC IDDetails
I20080906000080 OK Practitioner - Internal Medicine 3779484852 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Hospitalist Medicine Physicians of Texas, PLLC Internal Medicine CurrentSince Aug 1, 2021 Accepting new patients
Stillwater Medical Center Authority Internal Medicine CurrentSince Nov 10, 2020 Accepting new patients
Stillwater Medical Center Authority CurrentSince Nov 10, 2020 Accepting new patients
Poplar Physicians, LLC Internal Medicine PastSince Sep 1, 1997 Accepting new patients

Locations

3300 NW Expressway St
Oklahoma City, OK 73112
Phone (405) 251-2815

1000 N Lee Ave
Oklahoma City, OK 73102
Phone (405) 272-6152

417 Fairview Ave
Ponca City, OK 74601
Phone (580) 762-3770

1323 W 6th Ave
Stillwater, OK 74074
Phone (405) 372-1480

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1730234501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 S BRYANT AVE STE 101",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730346330",
            "telephone_number": "405-622-3063",
            "fax_number": "855-680-8890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 S BRYANT AVE STE 101",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730346330",
            "telephone_number": "405-622-3063",
            "fax_number": "855-680-8890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILKINSON",
        "first_name": "JOHN",
        "middle_name": "DAVID",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-24",
        "last_updated": "2023-03-07",
        "certification_date": "2021-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "14808",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "33487",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmond, OK

Sources for this page

Verify at the official NPI Registry.