Active NPI
Jeffrey Scott Wilson, M.D.
- Vascular Surgery Physician
- Temple Terrace, FL
National Provider Identifier
1841251055
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vascular Surgery Physician
- License
- ME101963
- Practice address
- 13085 N Telecom Pkwy
Temple Terrace, FL 33637-0926 - Phone
- (813) 971-3064
- NPI assigned
- Mar 29, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Trauma Surgery Physician | 2086S0127X | ME 101963 | FL | |
| Vascular Surgery Physician | 2086S0129X | ME101963 | FL | Primary |
Addresses
Primary practice location
13085 N Telecom Pkwy
Temple Terrace, FL 33637-0926
Mailing address
13085 N Telecom Pkwy
Temple Terrace, FL 33637-0926
Phone (813) 971-3064
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000293800 | Medicaid | FL | |
| 59056 | Other | FL | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME 101963 | FL | MD | Trauma Surgery Physician |
Interoperability endpoints
- https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.60143
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1386547200000",
"number": "1841251055",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13085 N TELECOM PKWY",
"city": "TEMPLE TERRACE",
"state": "FL",
"postal_code": "336370926",
"telephone_number": "813-971-3064"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13085 N TELECOM PKWY",
"city": "TEMPLE TERRACE",
"state": "FL",
"postal_code": "336370926",
"telephone_number": "813-971-3064"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JEFFREY",
"middle_name": "SCOTT",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-29",
"last_updated": "2013-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0127X",
"taxonomy_group": "",
"desc": "Surgery, Trauma Surgery",
"state": "FL",
"license": "ME 101963",
"primary": false
},
{
"code": "2086S0129X",
"taxonomy_group": "",
"desc": "Surgery, Vascular Surgery",
"state": "FL",
"license": "ME101963",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000293800",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "59056",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Temple Terrace, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.