Individual provider Active NPI

Carmen Ann Wilson, PA

  • Physician Assistant
  • Saint Louis, MO
National Provider Identifier
1780715896
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2000145768 Issued in MO
Practice address
4500 Forest Park Ave
Div Im Bone Marrow Transplant, 5TH, 6TH, 8TH FL
Saint Louis, MO 63108-2114
Phone
(314) 454-8304
Fax
(314) 454-5902
NPI assigned
Mar 8, 2007
Last updated
Apr 17, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2000145768 MO Primary

Addresses

Primary practice location

4500 Forest Park Ave
Div Im Bone Marrow Transplant, 5TH, 6TH, 8TH FL
Saint Louis, MO 63108-2114

Mailing address

PO Box 7412011
Chicago, IL 60674-2011
Phone (314) 454-8304

Other identifiers 1

IdentifierTypeStateIssuer
220024269MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20070719000453 MO Practitioner - Physician Assistant 0648287979 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Washington UniversityGroup PAC ID 9830008770, 2,968 clinicians

Practice addresses (Care Compare)

1 Barnes Jew Hosp PLZ
Saint Louis, MO 63110-1003
Phone (314) 747-3000

150 Entrance Way
St Peters Siteman Cancer Center
St Peters, MO 63376-1645
Phone (636) 916-9920

4500 Forest Park Ave
Saint Louis, MO 63108-2114

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.2 of 100Reported as group
Quality
71.6
Promoting interoperability
100
Improvement activities
40
Cost
75.75

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2000145768MOMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Washington University CurrentSince Dec 8, 2014 Accepting new patients
Washington University CurrentSince Dec 8, 2014 Accepting new patients
Washington University Past Accepting new patients
Physician Groups LC Past Accepting new patients
Washington University Physicians in Illinois, Inc Past Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

1418 Cross St
Ste 180
Shiloh, IL 62269
Phone (618) 607-1340

2630 Highway K
O Fallon, MO 63368
Phone (636) 240-5454

4500 Forest Park Ave
Fl 568
Saint Louis, MO 63108

4500 Forest Park Ave
Fl 8
Saint Louis, MO 63108
Phone (314) 454-8304

4921 Parkview Pl
Saint Louis, MO 63110
Phone (314) 747-4850

4921 Parkview Pl
Fl 7
Saint Louis, MO 63110
Phone (314) 362-6908

4921 Parkview Pl
Ste 7A
Saint Louis, MO 63110
Phone (314) 454-8304

4921 Parkview Pl
Ste 7A7B7C
Saint Louis, MO 63110

660 S Euclid Ave
Saint Louis, MO 63110

660 S Euclid Ave
#8052
Saint Louis, MO 63110
Phone (314) 454-8722

660 S Euclid Ave
#C
Saint Louis, MO 63110

8 Millstone Campus Dr
Saint Louis, MO 63146
Phone (314) 273-4375

150 Entrance Way
Saint Peters, MO 63376
Phone (636) 916-9920

Organizations & group practices 6

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 1

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": "1173312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1780715896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412011",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742011",
            "telephone_number": "314-454-8304",
            "fax_number": "314-454-5902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 FOREST PARK AVE",
            "address_2": "DIV IM BONE MARROW TRANSPLANT, 5TH, 6TH, 8TH FL",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631082114",
            "telephone_number": "314-454-8304",
            "fax_number": "314-454-5902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "CARMEN",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-08",
        "last_updated": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2000145768",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "220024269",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "4500 Forest Park Ave",
            "address_2": "Div IM Bone Marrow Transplant, 5th, 6th, 8th Fl",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631082114",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.