NPIMap

Individual provider Active NPI

Jack Edward Wilson, MD

  • Surgery Physician
  • Lemoyne, PA
National Provider Identifier
1790756542
Registry record updated Jan 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
MD025597E Issued in PA
Practice address
3 Walnut St Ste 100
Lemoyne, PA 17043
Phone
(717) 761-4141
Fax
(717) 761-1456
NPI assigned
Jan 30, 2006
Last updated
Jan 23, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X MD025597E PA Primary

Addresses

Primary practice location

3 Walnut St Ste 100
Lemoyne, PA 17043

Mailing address

409 S 2ND St
Suite 2F
Harrisburg, PA 17104-1612

Other identifiers 1

IdentifierTypeStateIssuer
000971496MedicaidPA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jwilson5928@phsdirect.pinnaclehealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20070221000517 PA Practitioner - General Surgery 7719089796 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Temple University School of Medicine, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pinnacle Health Medical ServicesGroup PAC ID 7618960493, 1,025 clinicians

Practice addresses (Care Compare)

3 Walnut St
100 Pinnacle Health Surgical Associates
Lemoyne, PA 17043-1168
Phone (717) 761-4141

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.08 of 100Reported as group
Quality
76.48
Promoting interoperability
100
Improvement activities
40
Cost
77.12

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy31
Hernia repair - groin (open)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD025597EPAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pinnacle Health Medical Services CurrentSince Apr 1, 2010 Accepting new patients
Pinnacle Health Medical Services CurrentSince Apr 1, 2010 Accepting new patients
Pinnacle Health Medical Services Surgery Current Accepting new patients
Upmc Pinnacle Hospitals Past Accepting new patients
Pinnacle Health Medical Services Past Accepting new patients

Locations

225 Grandview Ave
Ste 303
Camp Hill, PA 17011
Phone (717) 761-4141

2501 N 3rd St
Fl 2
Harrisburg, PA 17110
Phone (717) 782-2100

2626 N 3rd St
Ste 2B
Harrisburg, PA 17110
Phone (717) 231-8960

2808 Old Post Rd
Ste 104
Harrisburg, PA 17110
Phone (717) 545-4786

409 S 2nd St
Ste 2F
Harrisburg, PA 17104
Phone (717) 231-8049

3 Walnut St
Ste 100
Wormleysburg, PA 17043
Phone (717) 761-4141

Interoperability endpoints

  • Direct secure messaging: jwilson19224@upmc.direct-ci.com
  • Direct secure messaging: jwilson5928@phsdirect.pinnaclehealth.org

Organizations & group practices 5

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 7

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": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611360000000",
    "number": "1790756542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 S 2ND ST",
            "address_2": "SUITE 2F",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171041612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 WALNUT ST STE 100",
            "city": "LEMOYNE",
            "state": "PA",
            "postal_code": "17043",
            "telephone_number": "717-761-4141",
            "fax_number": "717-761-1456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JACK",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-30",
        "last_updated": "2021-01-23",
        "certification_date": "2021-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "MD025597E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000971496",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jwilson5928@phsdirect.pinnaclehealth.org",
            "affiliation": "N",
            "address_1": "3 Walnut St Ste 100",
            "city": "Lemoyne",
            "state": "PA",
            "country_code": "US",
            "postal_code": "17043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lemoyne, PA

Sources for this page

Verify at the official NPI Registry.