NPIMap

Individual provider Active NPI

Brian Patrick Wilson, D.O.

  • Gynecology Physician
  • Spencer, IA
National Provider Identifier
1871572404
Registry record updated Jun 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
License
03049 Issued in IA
Practice address
1823 Highway Blvd
Suite 5
Spencer, IA 51301-2226
Phone
(712) 262-6320
Fax
(712) 264-3007
NPI assigned
Jan 12, 2006
Last updated
Jun 19, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology Physician 207VG0400X 03049 IA Primary

Addresses

Primary practice location

1823 Highway Blvd
Suite 5
Spencer, IA 51301-2226

Mailing address

1823 Highway Blvd
Suite 5
Spencer, IA 51301-2226
Phone (712) 262-6320

Other identifiers 1

IdentifierTypeStateIssuer
0250886MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20110524000435 IA Practitioner - Obstetrics/Gynecology 8325221195 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Spencer Municipal HospitalGroup PAC ID 4183533060, 95 clinicians

Practice addresses (Care Compare)

101 E 10TH St
Suite 208
Spencer, IA 51301-4307
Phone (712) 264-6189

116 E 10TH St
Suite 101
Spencer, IA 51301-4365
Phone (712) 264-3500

1200 1St Ave E
Spencer, IA 51301-4330

1200 1St Ave E
Spencer, IA 51301-4342
Phone (712) 264-6198

1200 1St Ave E C
Nwia Bone Joint and Sports Surgeons
Spencer, IA 51301-4342
Phone (712) 262-7511

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10
Removal of the uterus17

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
03049IAMDGynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Spencer Municipal Hospital CurrentSince Apr 1, 2021 Accepting new patients
Northwest Iowa Surgeons PC Gynecology CurrentSince Jan 12, 2002 Accepting new patients
Spencer Municipal Hospital Current Accepting new patients
Spencer Municipal Hospital Current Accepting new patients
Spencer Municipal Hospital Gynecology CurrentSince Apr 1, 2021 Accepting new patients

Locations

101 E 10th St
Ste 101
Spencer, IA 51301
Phone (712) 264-3500

1200 1st Ave E
Spencer, IA 51301
Phone (712) 264-6164

1823 Highway Blvd
Ste 5
Spencer, IA 51301
Phone (605) 335-3349

400 10th St E
Waconia, MN 55387

Interoperability endpoints

  • Direct secure messaging: brian.wilson@nwias.directbygreenway.com
  • Direct secure messaging: brian.wilson2@avera.sdhealthlink.net

Organizations & group practices 5

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.

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": "1137024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245369600000",
    "number": "1871572404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1823 HIGHWAY BLVD",
            "address_2": "SUITE 5",
            "city": "SPENCER",
            "state": "IA",
            "postal_code": "513012226",
            "telephone_number": "712-262-6320",
            "fax_number": "712-264-3007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1823 HIGHWAY BLVD",
            "address_2": "SUITE 5",
            "city": "SPENCER",
            "state": "IA",
            "postal_code": "513012226",
            "telephone_number": "712-262-6320",
            "fax_number": "712-264-3007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "BRIAN",
        "middle_name": "PATRICK",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-12",
        "last_updated": "2009-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "IA",
            "license": "03049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0250886",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spencer, IA

Sources for this page

Verify at the official NPI Registry.