NPIMap

Individual provider Active NPI

Jack J Wilson, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Richmond, VA
National Provider Identifier
1851378145
Registry record updated Jan 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
304638 Issued in LA
Practice address
5801 Bremo Rd
Richmond, VA 23226-1907
Phone
(804) 281-8100
Fax
(804) 285-7419
NPI assigned
Dec 28, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2019

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X ME58840 FL
Hematology (Pathology) Physician 207ZH0000X 58840 FL
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 58840 FL
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 304638 LA Primary

Addresses

Primary practice location

5801 Bremo Rd
Richmond, VA 23226-1907

Mailing address

1514 Jefferson Hwy
New Orleans, LA 70121-2429
Phone (504) 842-4000

Other practice location 1

1514 Jefferson Hwy
New Orleans, LA 70121-2429
Phone (504) 842-3330

Other identifiers 1

IdentifierTypeStateIssuer
052455700MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20190411001192 VA Practitioner - Pathology 8224100508 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
University of Alabama School of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Monument Pathologists Inc.Group PAC ID 0840260360, 11 clinicians

Practice addresses (Care Compare)

101 Harris Rd
Kilmarnock, VA 22482-3880
Phone (804) 435-8000

13710 St Francis Blvd
Midlothian, VA 23114-3267
Phone (804) 594-7300

1500 N 28TH St
Richmond, VA 23223-5332
Phone (804) 281-8100

200 Medical Park Blvd
Petersburg, VA 23805-9274
Phone (804) 281-8100

5801 Bremo Rd
Richmond, VA 23226-1907

8260 Atlee Rd
Mechanicsville, VA 23116-1844
Phone (804) 254-6000

Hospital & facility affiliations

  • Bon Secours St Marys Hospital Hospital, Richmond, VA, CCN 490059
  • Bon Secours St Francis Medical Center Hospital, Midlothian, VA, CCN 490136
  • Bon Secours Memorial Regional Medical Center Hospital, Mechanicsville, VA, CCN 490069
  • Bon Secours Southside Medical Center Hospital, Petersburg, VA, CCN 490067
  • Bon Secours Richmond Community Hospital Hospital, Richmond, VA, CCN 490094

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME58840FLMDObstetrics & Gynecology Physician
58840FLMDHematology (Pathology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Monument Pathologists Inc Anatomic Pathology & Clinical Pathology CurrentSince Jan 22, 2019 Accepting new patients

Locations

601 Watkins Centre Pkwy
Midlothian, VA 23114
Phone (804) 594-2100

13710 St Francis Blvd
Midlothian, VA 23114
Phone (804) 594-7300

5801 Bremo Rd
Richmond, VA 23226
Phone (804) 281-8220

Organizations & group practices 1

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 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1135728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548720000000",
    "number": "1851378145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1514 JEFFERSON HWY",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701212429",
            "telephone_number": "504-842-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5801 BREMO RD",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232261907",
            "telephone_number": "804-281-8100",
            "fax_number": "804-285-7419"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1514 Jefferson Hwy",
            "address_purpose": "LOCATION",
            "city": "New Orleans",
            "state": "LA",
            "postal_code": "701212429",
            "country_code": "US",
            "telephone_number": "504-842-3330",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JACK",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-28",
        "last_updated": "2019-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "FL",
            "license": "ME58840",
            "primary": false
        },
        {
            "code": "207ZH0000X",
            "taxonomy_group": "",
            "desc": "Pathology, Hematology",
            "state": "FL",
            "license": "58840",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "FL",
            "license": "58840",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "LA",
            "license": "304638",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "052455700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, VA

Sources for this page

Verify at the official NPI Registry.