Individual provider Active NPI

Eneida B Wilson, DPT

  • Physical Therapist
  • Philadelphia, PA
National Provider Identifier
1801267034
Registry record updated Feb 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT024535 Issued in PA
Practice address
5300 Chester Ave
Philadelphia, PA 19143-4929
Phone
(215) 727-0411
NPI assigned
Oct 14, 2015
Last updated
Feb 7, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT024535 PA Primary

Addresses

Primary practice location

5300 Chester Ave
Philadelphia, PA 19143-4929

Mailing address

5300 Chester Ave
Philadelphia, PA 19143-4929

Other identifiers 1

IdentifierTypeStateIssuer
N/AOtherN/A

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171207000085 PA Practitioner - Physical Therapist in Private Practice 2163789736 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Progress Physical Therapy LLCGroup PAC ID 1951530849, 430 clinicians

Practice addresses (Care Compare)

3300 Grant Ave
Suite 19C
Philadelphia, PA 19114-2632
Phone (215) 851-1661

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT024535PAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Progress Physical Therapy LLC Physical Therapist CurrentSince Jan 21, 2019 Accepting new patients

Locations

3300 Grant Ave
Ste 19C
Philadelphia, PA 19114
Phone (215) 754-8743

920 W Sproul Rd
Ste 101
Springfield, PA 19064

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1444780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549497600000",
    "number": "1801267034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 CHESTER AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191434929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 CHESTER AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191434929",
            "telephone_number": "215-727-0411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "ENEIDA",
        "middle_name": "B",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-14",
        "last_updated": "2019-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT024535",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "N/A",
            "identifier": "N/A",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.