Individual provider Active NPI

William Bennett Wilson, M.D.

  • Anesthesiology Physician
  • Waco, TX
National Provider Identifier
1790197143
Registry record updated Jul 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
R6713 Issued in TX
Practice address
405 Londonderry Dr Ste 105
Waco, TX 76712-7920
Phone
(254) 776-0266
NPI assigned
May 20, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Anesthesiology Physician 207L00000X R6713 TX Primary

Addresses

Primary practice location

405 Londonderry Dr Ste 105
Waco, TX 76712-7920

Mailing address

405 Londonderry Dr Ste 105
Waco, TX 76712-7920
Phone (254) 776-0266

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20180531001877 TX Practitioner - Anesthesiology 3870880974 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Texas Medical School at San Antonio, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mid Tex Anesthesia Associates, P.a.Group PAC ID 5395815369, 28 clinicians

Practice addresses (Care Compare)

405 Londonderry Dr
Suite 105
Waco, TX 76712-7920
Phone (254) 776-0266

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
36.76 of 100Reported as group
Quality
43.25
Improvement activities
0

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R6713TXMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Health System, Inc. Past Accepting new patients
Baptist Health System, Inc. Past Accepting new patients

Organizations & group practices 3

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.

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": "1400544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689033600000",
    "number": "1790197143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 LONDONDERRY DR STE 105",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767127920",
            "telephone_number": "254-776-0266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 LONDONDERRY DR STE 105",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767127920",
            "telephone_number": "254-776-0266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "WILLIAM",
        "middle_name": "BENNETT",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-20",
        "last_updated": "2023-07-11",
        "certification_date": "2023-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "TX",
            "license": "R6713",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waco, TX

Sources for this page

Verify at the official NPI Registry.