Organization Active NPI

Wilson Family Medicine, PA

  • Family Medicine Physician
  • Wilson, NC
National Provider Identifier
1831151091
Registry record updated May 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WILSON FAMILY MEDICINE, PA
Practice address
3324 Heritage Drive
Wilson, NC 27893-9232
Phone
(252) 237-7770
Fax
(252) 291-7779
NPI assigned
Apr 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2016

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

Authorized official

Name
Trent Wester, MDNPI 1700871423
Title
President
Phone
(252) 237-7770

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

3324 Heritage Drive
Wilson, NC 27893-9232

Mailing address

3324 Heritage Drive
Wilson, NC 27893-9232
Phone (252) 237-7770

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100331001032 NC Part B Supplier - Clinic/Group Practice 4587642475 Receives reassigned benefits from 2 practitioners
Practice locations: Wilson, NC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D1025657Wilson Family Medicine PA3324 Heritage Drive, Wilson, NC 27893Certificate of waiverMay 12, 2028

National Provider Directory

National Provider Directory

Locations

3324 Heritage Dr
Wilson, NC 27893
Phone (252) 237-7770

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462838400000",
    "number": "1831151091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3324 HERITAGE DRIVE",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278939232",
            "telephone_number": "252-237-7770",
            "fax_number": "252-291-7779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3324 HERITAGE DRIVE",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278939232",
            "telephone_number": "252-237-7770",
            "fax_number": "252-291-7779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSON FAMILY MEDICINE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-04",
        "last_updated": "2016-05-10",
        "status": "A",
        "authorized_official_last_name": "WESTER",
        "authorized_official_first_name": "TRENT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "252-237-7770",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilson, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2016; 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.