NPIMap

Individual provider Active NPI

Michaeleen N Wilson, DO

  • Family Medicine Physician
  • Nanty Glo, PA
National Provider Identifier
1861519985
Registry record updated Jun 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS013463 Issued in PA
Practice address
1060 Lloyd St
Nanty Glo, PA 15943-1232
Phone
(814) 749-8624
Fax
(814) 749-8248
NPI assigned
Mar 23, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS013463 PA Primary

Addresses

Primary practice location

1060 Lloyd St
Nanty Glo, PA 15943-1232

Mailing address

1086 Franklin St
Johnstown, PA 15905-4305
Phone (814) 410-8300

Other identifiers 1

IdentifierTypeStateIssuer
1019376240001MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20070626000002 PA Practitioner - Family Practice 6305945734 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Lake Erie College of Osteopathic Medicine, Erie, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vantage Physical Therapy and Rehabilitation IncGroup PAC ID 3072424886, 253 clinicians

Practice addresses (Care Compare)

1060 Lloyd St
Nanty Glo, PA 15943-1232
Phone (814) 247-3100

336 Bloomfield St
Johnstown, PA 15904-3271
Phone (814) 269-2224

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS013463PAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
DLP Conemaugh Physician Practices LLC Family Medicine CurrentSince Sep 1, 2014 Accepting new patients
DLP Conemaugh Physician Practices LLC Family Medicine Current Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Conemaugh Health Initiatives Past Accepting new patients
DLP Conemaugh Memorial Medical Center LLC Past Accepting new patients
Windber Hospital, Inc. Past Accepting new patients

Locations

236 Jamesway Rd
Ebensburg, PA 15931
Phone (814) 471-6595

1450 Scalp Ave
Ste 1000
Johnstown, PA 15904
Phone (814) 269-5200

1111 Franklin St
Ste 180
Johnstown, PA 15905
Phone (814) 534-3740

1086 Franklin St
Johnstown, PA 15905
Phone (610) 250-4540

1020 Franklin St
Johnstown, PA 15905
Phone (814) 533-1095

1060 Lloyd St
Nanty Glo, PA 15943
Phone (814) 536-6671

330 Seven Springs Way
Brentwood, TN 37027
Phone (615) 920-7780

Interoperability endpoints

  • Direct secure messaging: mwilson8379@direct.conemaugh.org

Organizations & group practices 7

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 7

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": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277251200000",
    "number": "1861519985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1086 FRANKLIN ST",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159054305",
            "telephone_number": "814-410-8300",
            "fax_number": "814-410-8331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 LLOYD ST",
            "city": "NANTY GLO",
            "state": "PA",
            "postal_code": "159431232",
            "telephone_number": "814-749-8624",
            "fax_number": "814-749-8248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MICHAELEEN",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-23",
        "last_updated": "2010-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS013463",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1019376240001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nanty Glo, PA

Sources for this page

Verify at the official NPI Registry.