Matthew Blake Wilson

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

4461 Issued in TN

Practice address

175 Enoch Blvd
Savannah, TN 38372-2240

Phone

(731) 925-2300

NPI assigned

Jan 7, 2019

Last updated

Aug 26, 2024By 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 TN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: matthew.wilson.p1@direct.lifespanhealth.nextgenshare.com

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.

• Hardin County Regional Health Center

  dba Lifespan Health

  • Federally Qualified Health Center (FQHC)
  • Savannah, TN
  • NPI 1184676157
  Medicare reassignment NPD
• Hardin County Regional Health Center

  dba Lifespan Health

  • Federally Qualified Health Center (FQHC)
  • Savannah, TN
  • NPI 1013509223
  NPD

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

{
    "created_epoch": "1546819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1871066456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 655",
            "city": "SAVANNAH",
            "state": "TN",
            "postal_code": "383720655",
            "telephone_number": "731-925-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 ENOCH BLVD",
            "city": "SAVANNAH",
            "state": "TN",
            "postal_code": "383722240",
            "telephone_number": "731-925-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MATTHEW",
        "middle_name": "BLAKE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-01-07",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TN",
            "license": "4461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kennedy S Wilkes, APRN
• William F. Conway, MD, Inc
• Daniel R Williams
• Michelle Williams, FNP-C
• Teresa Carol Williams, DPH
• Nicole Denise Wilson, APN
• Katie Wintermute, BA
• Women and Childrens Healthcare Center PLLC
• Sherry Lynn Woodard, COTA
• Julia Blair Woods, LPC-MHSP

• Professional Counselor in Savannah, TN
• Providers in Savannah, TN by specialty
• Professional Counselor in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; 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.