Active NPI
Addison R Wilson, M.D.
- Family Medicine Physician
- Portland, OR
National Provider Identifier
1861424764
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD17686
- Practice address
- 15285 NW Central Dr
Portland, OR 97229-0973 - Phone
- (503) 216-9060
- Fax
- (503) 216-9098
- NPI assigned
- Jul 7, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD17686 | OR | Primary |
Addresses
Primary practice location
15285 NW Central Dr
Portland, OR 97229-0973
Mailing address
PO Box 13994
Portland, OR 97213-0994
Phone (503) 215-6494
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1861424764",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 13994",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972130994",
"telephone_number": "503-215-6494",
"fax_number": "503-215-6644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15285 NW CENTRAL DR",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972290973",
"telephone_number": "503-216-9060",
"fax_number": "503-216-9098"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "ADDISON",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OR",
"license": "MD17686",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.