Active NPI
Bennett Leroy Wilson, DO
- Clinical Pathology/Laboratory Medicine Physician
- Madison, WI
National Provider Identifier
1891223616
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Pathology/Laboratory Medicine Physician
- License
- 82161-21
- Practice address
- 600 Highland Ave
Madison, WI 53792-0001 - Phone
- (608) 263-8443
- NPI assigned
- May 24, 2017
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Pathology/Laboratory Medicine Physician | 207ZP0105X | 82161-21 | WI | Primary |
Addresses
Primary practice location
600 Highland Ave
Madison, WI 53792-0001
Mailing address
7974 Uw Health CT
Middleton, WI 53562-5531
Other practice location 1
601 Elmwood Ave Box 626
Rochester, NY 14642-0001
Phone (585) 273-4580
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0039 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260618003196 | WI | Practitioner - Pathology | 0143792242 |
Care Compare profile
Medicare Care Compare- Specialty
- Pathology
- Education
- Kansas City University of Med & Biosciences, College of Osteo Med, 2017
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
7974 Uw Health CT
Middleton, WI 53562-5531
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1495584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1782345600000",
"number": "1891223616",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7974 UW HEALTH CT",
"city": "MIDDLETON",
"state": "WI",
"postal_code": "535625531"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 HIGHLAND AVE",
"city": "MADISON",
"state": "WI",
"postal_code": "537920001",
"telephone_number": "608-263-8443"
}
],
"practiceLocations": [
{
"address_1": "601 Elmwood Ave Box 626",
"address_purpose": "LOCATION",
"city": "Rochester",
"state": "NY",
"postal_code": "146420001",
"country_code": "US",
"telephone_number": "585-273-4580",
"fax_number": "585-276-1350",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILSON",
"first_name": "BENNETT",
"middle_name": "LEROY",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-05-24",
"last_updated": "2026-06-25",
"certification_date": "2026-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0105X",
"taxonomy_group": "",
"desc": "Pathology, Clinical Pathology/Laboratory Medicine",
"state": "WI",
"license": "82161-21",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0039",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2026; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.