Walter Wilson Jr., MD

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

54415 Issued in KY

Practice address

215 E 11TH St
Newport, KY 41071-2203

Phone

(859) 655-6100

NPI assigned

Apr 21, 2015

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 1

Medicare fee-for-service enrollment

Enrolled in KY

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

Specialty

Psychiatry

Education

State University of New York at Stony Brook, School of Medicine, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Abs Lincs Ky, LLC.Group PAC ID 6608833520, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: wwilson405104@direct.vumc.org

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.

• Abs Lincs Ky, LLC

  • Psychiatry Physician
  • Hopkinsville, KY
  • NPI 1720353501
  Medicare reassignment Care Compare group NPD
• Abs Lincs Ky, LLC

  • Psychiatric Hospital
  • Hopkinsville, KY
  • NPI 1750392502
  NPD (past)

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

{
    "created_epoch": "1429574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617235200000",
    "number": "1821485400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 E 11TH ST",
            "city": "NEWPORT",
            "state": "KY",
            "postal_code": "410712203",
            "telephone_number": "859-655-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 E 11TH ST",
            "city": "NEWPORT",
            "state": "KY",
            "postal_code": "410712203",
            "telephone_number": "859-655-6100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1401 Madison Ave",
            "address_purpose": "LOCATION",
            "city": "Covington",
            "state": "KY",
            "postal_code": "410113313",
            "country_code": "US",
            "telephone_number": "859-655-6100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "WALTER",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-21",
        "last_updated": "2021-04-01",
        "certification_date": "2021-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "KY",
            "license": "54415",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KY LICENSE",
            "identifier": "54415",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Molly Woods
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• Child & Adolescent Psychiatry Physician in Newport, KY
• Providers in Newport, KY by specialty
• Child & Adolescent Psychiatry Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2021; 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.
• 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.