Keith Alan Wilson, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA18722 Issued in CA

Practice address

12550 Hesperia Road
Suite100
Victorville, CA 92395-0000

Phone

(760) 241-6666

Fax

(760) 241-7575

NPI assigned

Nov 11, 2007

Last updated

Mar 27, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Dr.Mikel Walk in Clinic Inc

  • Family Medicine Physician
  • Hesperia, CA
  • NPI 1346250396
  Medicare reassignment NPD (past)
• Maithri N. Weerasinghe MD Inc

  dba Dr Mike's Walk In Clinic

  • Family Medicine Physician
  • Barstow, CA
  • NPI 1295745743
  Medicare reassignment
• Providence Medical Foundation

  • Family Medicine Physician
  • Brea, CA
  • NPI 1871607762
  Medicare reassignment
• Dr, Mikel Walk in Clinic

  • General Practice Physician
  • Victorville, CA
  • NPI 1942428263
  NPD
• Providence Medical Foundation

  • Surgery Physician
  • Eureka, CA
  • NPI 1477790517
  NPD
• Providence Medical Foundation

  • Family Medicine Physician
  • Anaheim, CA
  • NPI 1639715709
  NPD
• High Desert Primary Care

  • Internal Medicine Physician
  • Victorville, CA
  • NPI 1770537466
  NPD (past)

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

{
    "created_epoch": "1194739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553644800000",
    "number": "1841470507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12143 NAVAJO RD",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923087250",
            "telephone_number": "760-240-1144",
            "fax_number": "760-240-9127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12550 HESPERIA ROAD",
            "address_2": "SUITE100",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923950000",
            "telephone_number": "760-241-6666",
            "fax_number": "760-241-7575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KEITH",
        "middle_name": "ALAN",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-11",
        "last_updated": "2019-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA18722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristina Wilmoth
• Elsie Wilridge
• Demetris Wilson
• Erica Wilson
• Germia Wilson
• Wimbledon Park Physical Therapy
• Jeremy L Winderweedle, PA-C
• Patsy Jane Winderweedle, LMFT
• Tamara Winegardner
• Mary Winkler

• Physician Assistant in Victorville, CA
• Providers in Victorville, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2019; 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.