Russell Carl Wilson, P.A.-C, A.T.C.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA06802 Issued in TX

Practice address

1125 Raintree Cir Ste 100
Allen, TX 75013-5289

Phone

(972) 727-9995

Fax

(972) 727-8350

NPI assigned

Nov 4, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX, CO2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

MedhealthGroup PAC ID 9931001567, 435 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Methodist McKinney Hospital Hospital, McKinney, TX, CCN 670069

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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 and National Provider Directory roles.

• Medhealth

  • Family Medicine Physician
  • Dallas, TX
  • NPI 1912957200
  Medicare reassignment Care Compare group NPD
• Doctx3 PLLC

  • Orthopaedic Surgery Physician
  • Irving, TX
  • NPI 1467808618
  Medicare reassignment NPD
• True North Health Navigation LLC

  • Emergency Medicine Physician
  • Denver, CO
  • NPI 1740622133
  Medicare reassignment
• Medhealth

  • Urgent Care Clinic/Center
  • Grand Prairie, TX
  • NPI 1558762690
  NPD
• Advanced Pain & Rehabilitation Association PLLC

  • Physical Medicine & Rehabilitation Physician
  • Wylie, TX
  • NPI 1215404637
  NPD (past)

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

• Methodist McKinney Hospital LLC

  • General Acute Care Hospital
  • McKinney, TX
  • NPI 1952538431
  Care Compare affiliation

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

{
    "created_epoch": "1131062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663632000000",
    "number": "1780675967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 RAINTREE CIR STE 100",
            "city": "ALLEN",
            "state": "TX",
            "postal_code": "750135289",
            "telephone_number": "972-727-9995",
            "fax_number": "972-727-8350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 RAINTREE CIR STE 100",
            "city": "ALLEN",
            "state": "TX",
            "postal_code": "750135289",
            "telephone_number": "972-727-9995",
            "fax_number": "972-727-8350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "RUSSELL",
        "middle_name": "CARL",
        "name_prefix": "Mr.",
        "credential": "P.A.-C, A.T.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-04",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146L00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Paramedic",
            "state": "TX",
            "license": "45448",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NE",
            "license": "020202111",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0005767",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "1092900",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA06802",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "360930704",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSTX",
            "identifier": "8029NH",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Willow Tree Therapy Group, PLLC
• John Roy Wilson, LPC
• Jonathan Wilson
• Ken Wilson II, D.C.
• Madison Wilson, RBT
• John Harold Wimbish, O.D.
• Tyler Winfield, DC
• Tammy Lynn Winford, CSFA
• Victoria Yvette Winters, COTA
• Elizabeth Witowich

• Physician Assistant in Allen, TX
• Providers in Allen, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2022; 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.