David P Wilson, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

G37216 Issued in CA

Practice address

11219 N Highway 3
Fort Jones, CA 96032-9731

Phone

(530) 468-5766

Fax

(530) 842-9054

NPI assigned

Jun 14, 2005

Reactivated

Mar 23, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Hospitalist Medicine Physicians of California, Inc

  • Internal Medicine Physician
  • Apple Valley, CA
  • NPI 1184663965
  Medicare reassignment NPD
• Inpatient Specialists of California, PC

  • Internal Medicine Physician
  • San Bernardino, CA
  • NPI 1952792475
  Medicare reassignment NPD
• Marble Mountain Health

  • Internal Medicine Physician
  • Fort Jones, CA
  • NPI 1568639615
  NPD (past) Authorized official
• Siskiyou Hospital, Inc.

  dba Fairchild Medical Center

  • Critical Access Hospital
  • Yreka, CA
  • NPI 1093892275
  NPD
• Lakeport Emergency Medical Corporation

  • Emergency Medicine Physician
  • Lakeport, CA
  • NPI 1376636597
  NPD (past)
• Inland Empire Hospital Services Association

  dba Family Medicine of Spokane

  • Family Medicine Physician
  • Spokane, WA
  • NPI 1326002163
  NPD (past)

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

{
    "created_epoch": "1118707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327017600000",
    "number": "1801891130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 458",
            "city": "FORT JONES",
            "state": "CA",
            "postal_code": "960320458",
            "telephone_number": "530-468-5766",
            "fax_number": "530-842-9054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11219 N HIGHWAY 3",
            "city": "FORT JONES",
            "state": "CA",
            "postal_code": "960329731",
            "telephone_number": "530-468-5766",
            "fax_number": "530-842-9054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "DAVID",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-14",
        "last_updated": "2012-01-20",
        "deactivation_date": "2006-03-16",
        "reactivation_date": "2006-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G37216",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "G37216",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G72161",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G372162",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "G37216",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cynthia Victoria Samuel, RADT
• Scott Valley Physical Therapy and Fitness Center, PC
• Scott Valley Unified School District
• Brent Alan Webb, DDS
• Karyn Elizabeth Williams-Stanshaw, LVN
• Norma K. Young, FNP-C

• Internal Medicine Physician in Fort Jones, CA
• Providers in Fort Jones, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.