Individual provider Active NPI

Nathaniel K Wilkin, MD

  • Dermatology Physician
  • Columbus, OH
National Provider Identifier
1790895415
Registry record updated Apr 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
200501355 Issued in NC
Practice address
300 W Spring St Unit 1204
Columbus, OH 43215-7656
Phone
(614) 452-9800
Fax
(614) 448-2720
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 4, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 200501355 NC Primary

Addresses

Primary practice location

300 W Spring St Unit 1204
Columbus, OH 43215-7656

Mailing address

PO Box 16297
Beverly Hills, CA 90209-2297
Phone (661) 947-9000

Other identifiers 2

IdentifierTypeStateIssuer
H88905OtherOHUPIN
5901558MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20121015000256 CA Practitioner - Dermatology 3375575277 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
200501355NCMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health Physicians Network Current Accepting new patients
Adventist Health Physicians Network CurrentSince May 1, 2017 Accepting new patients
Adventist Health Physicians Network CurrentSince May 1, 2017 Accepting new patients
Central Ohio Skin & Cancer Inc Dermatology Past Accepting new patients
Central Ohio Skin & Cancer Inc Dermatology Past Accepting new patients

Locations

1524 W Lacey Blvd
Ste 101
Hanford, CA 93230
Phone (559) 583-4695

1524 W Lacey Blvd
Ste 206
Hanford, CA 93230
Phone (559) 583-4507

1142 Rose Ave
Ste A
Selma, CA 93662
Phone (559) 779-9222

1041 Rose Ave
Selma, CA 93662
Phone (559) 856-6090

1142 Rose Ave
Ste C
Selma, CA 93662
Phone (559) 856-6165

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459728000000",
    "number": "1790895415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 16297",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902092297",
            "telephone_number": "661-947-9000",
            "fax_number": "310-446-4408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W SPRING ST UNIT 1204",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432157656",
            "telephone_number": "614-452-9800",
            "fax_number": "614-448-2720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILKIN",
        "first_name": "NATHANIEL",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2016-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NC",
            "license": "200501355",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "H88905",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5901558",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.