Active NPI
Rodgers M Wilson, M.D.
- Psychiatry Physician
- Philadelphia, PA
National Provider Identifier
1891745931
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- MD424283
- Practice address
- 4641 Roosevelt Blvd
Philadelphia, PA 19124-2343 - Phone
- (215) 831-4600
- Fax
- (215) 831-6984
- NPI assigned
- May 11, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | MD424283 | PA | Primary |
Addresses
Primary practice location
4641 Roosevelt Blvd
Philadelphia, PA 19124-2343
Mailing address
4641 Roosevelt Blvd
Philadelphia, PA 19124-2343
Phone (215) 831-4600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101127811-001 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD424283 | PA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1336435200000",
"number": "1891745931",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4641 ROOSEVELT BLVD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191242343",
"telephone_number": "215-831-4600",
"fax_number": "215-831-6984"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4641 ROOSEVELT BLVD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191242343",
"telephone_number": "215-831-4600",
"fax_number": "215-831-6984"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "RODGERS",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-11",
"last_updated": "2012-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "PA",
"license": "MD424283",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "101127811-001",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.