Jeffrey K Wilson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01037768A Issued in IN

Practice address

5111 Clinton Dr
Kokomo, IN 46902-7136

Phone

(765) 457-8381

Fax

(765) 457-4443

NPI assigned

Mar 19, 2007

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Nora Urgent Care LLC

  • Urgent Care Clinic/Center
  • Indianapolis, IN
  • NPI 1033548896
  Medicare reassignment NPD
• Nora Urgent Care LLC

  • Urgent Care Clinic/Center
  • Indianapolis, IN
  • NPI 1568932002
  NPD
• American Health Network of Indiana, LLC

  • Family Medicine Physician
  • Mulberry, IN
  • NPI 1033220017
  NPD (past)

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414108800000",
    "number": "1881718286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5111 CLINTON DR",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469027136",
            "telephone_number": "765-457-8381",
            "fax_number": "765-457-4443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5111 CLINTON DR",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469027136",
            "telephone_number": "765-457-8381",
            "fax_number": "765-457-4443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JEFFREY",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-19",
        "last_updated": "2014-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01037768A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100319130E",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000000524563",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ronald Williams, LCSW, CADAC II
• Shannon Williams, RBT
• Cora Rose Marie Willits
• Willowcare Home Health Care, LLC
• Tyrelle Wills
• Katherine Riley Wilson, RBT
• Riley Wilson
• Stephanie Renae Wilson, BCBA
• Liyla Ann Winchester
• Michelle Lynn Winegardner, PT

• Family Medicine Physician in Kokomo, IN
• Providers in Kokomo, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2014; 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.