NPIMap

Individual provider Active NPI

Derron Wilson, MD

  • Pain Medicine (Anesthesiology) Physician
  • Carmel, IN
National Provider Identifier
1780669267
Registry record updated Feb 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
01047150A Issued in IN
Practice address
13345 Illinois St
Carmel, IN 46032-3318
Phone
(317) 396-1300
Fax
(317) 870-2728
NPI assigned
Dec 7, 2005
Last updated
Feb 22, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X 01047150A IN Primary

Addresses

Primary practice location

13345 Illinois St
Carmel, IN 46032-3318

Mailing address

13345 Illinois St
Carmel, IN 46032-3318
Phone (317) 396-1300

Other identifiers 1

IdentifierTypeStateIssuer
200313770BMedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address derron.wilsonmd.p1@direct.goodmancampbell.nextgenshare.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041221000076 IN Practitioner - AnesthesiologyPractitioner - Pain Management 6608834858 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
AnesthesiologyAlso: Pain Management
Education
Indiana University School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

13345 Illinois St
Carmel, IN 46032-3018

13345 Illinois St
Carmel, IN 46032-3318
Phone (317) 396-1451

1513 N 6TH
Terre Haute, IN 47807-1039
Phone (812) 232-0564

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Union Associated Physicians Clinic, LLC CurrentSince Jun 10, 2024 Accepting new patients
Union Associated Physicians Clinic LLC CurrentSince Jun 10, 2024 Accepting new patients
Union Hospital Inc. Current Accepting new patients
Indianapolis Neurosurgical Group PC CurrentSince Dec 14, 2003 Accepting new patients
Indianapolis Neurosurgical Group PC Pain Medicine CurrentSince Dec 14, 2003 Accepting new patients
Johnson Memorial Hospital Past Accepting new patients
Major Hospital Past Accepting new patients

Locations

13345 Illinois St
Carmel, IN 46032
Phone (317) 396-1328

1051 Greenwood Springs Blvd
#201
Greenwood, IN 46143

8333 Naab Rd
Ste 250
Indianapolis, IN 46260
Phone (317) 338-5100

1513 N 6th St
Terre Haute, IN 47807
Phone (812) 238-7631

221 S 6th St
Terre Haute, IN 47807
Phone (812) 242-3157

Interoperability endpoints

  • Direct secure messaging: dwilson2@unionhealth.cernerdirect.com
  • Direct secure messaging: derron.wilson.p1@direct.goodmancampbell.nextgenshare.com

Organizations & group practices 7

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1133913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613952000000",
    "number": "1780669267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13345 ILLINOIS ST",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460323318",
            "telephone_number": "317-396-1300",
            "fax_number": "317-870-2728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13345 ILLINOIS ST",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460323318",
            "telephone_number": "317-396-1300",
            "fax_number": "317-870-2728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "DERRON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-07",
        "last_updated": "2021-02-22",
        "certification_date": "2021-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "IN",
            "license": "01047150A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200313770B",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "derron.wilsonmd.p1@direct.goodmancampbell.nextgenshare.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "13345 Illinois St",
            "city": "Carmel",
            "state": "IN",
            "country_code": "US",
            "postal_code": "460323318",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Carmel, IN

Sources for this page

Verify at the official NPI Registry.