NPIMap

Individual provider Active NPI

Andrea Gail Wilson, PA

  • Surgical Physician Assistant
  • Decorah, IA
National Provider Identifier
1841282217
Registry record updated May 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
001466 Issued in IA
Practice address
1830 State Highway 9
Decorah, IA 52101-7301
Phone
(563) 382-3140
NPI assigned
Aug 22, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 001466 IA
Surgical Physician Assistant 363AS0400X 001466 IA Primary

Addresses

Primary practice location

1830 State Highway 9
Decorah, IA 52101-7301

Mailing address

1836 South Ave
La Crosse, WI 54601-5429
Phone (608) 782-7300

Other identifiers 1

IdentifierTypeStateIssuer
33065OtherIAWELLMARK BCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100330000312 IA Practitioner - Physician Assistant 0244366276 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gundersen Regional Clinics, LLCGroup PAC ID 8820450919, 51 clinicians

Practice addresses (Care Compare)

1830 State Hwy 9
Suite 100
Decorah, IA 52101-7301
Phone (563) 382-3140

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
001466IAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Gundersen Regional Clinics LLC CurrentSince Oct 1, 2023 Accepting new patients
Gundersen Lutheran Express Care, Inc CurrentSince Sep 26, 2012 Accepting new patients
Gundersen Clinic LTD CurrentSince Sep 26, 2012 Accepting new patients
Palmer Lutheran Health Center, Inc. CurrentSince Jul 1, 2016 Accepting new patients

Locations

235 8th Ave W
Cresco, IA 52136
Phone (319) 547-2101

1830 State Highway 9
Ste 100
Decorah, IA 52101
Phone (563) 382-3140

1830 State Highway 9
Decorah, IA 52101
Phone (563) 382-2639

112 Jefferson St
West Union, IA 52175
Phone (563) 422-3811

1836 South Ave
La Crosse, WI 54601
Phone (608) 788-8102

Interoperability endpoints

  • Direct secure messaging: awilson115317@uihcdirect.org
  • Direct secure messaging: awilson58098@direct.emplifyhealth.org

Organizations & group practices 5

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.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1124668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431648000000",
    "number": "1841282217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1836 SOUTH AVE",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546015429",
            "telephone_number": "608-782-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1830 STATE HIGHWAY 9",
            "city": "DECORAH",
            "state": "IA",
            "postal_code": "521017301",
            "telephone_number": "563-382-3140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "ANDREA",
        "middle_name": "GAIL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-22",
        "last_updated": "2015-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "001466",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IA",
            "license": "001466",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BCBS",
            "identifier": "33065",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Decorah, IA

Sources for this page

Verify at the official NPI Registry.