Active NPI
John Winkle Wilson Jr., M.D.
- Internal Medicine Physician
- Conway, SC
National Provider Identifier
1891750782
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 3974
- Practice address
- 8002 Myrtle Trace Dr
Conway, SC 29526-8945 - Phone
- (843) 347-7227
- NPI assigned
- Apr 20, 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 3974 | SC | Primary |
Addresses
Primary practice location
8002 Myrtle Trace Dr
Conway, SC 29526-8945
Mailing address
PO Box 50760
Myrtle Beach, SC 29579-0013
Phone (843) 234-5139
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 039746 | Medicaid | SC | |
| GP4505 | Medicaid | SC |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Conway Hospital Long Term Care Services, Inc | Past | Accepting new patients | |
| Conway Hospital Community Services | Past | Accepting new patients | |
| Conway Hospital, Inc. | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Obstetrics & Gynecology Physician
- Conway, SC
- NPI 1043632805
-
- Nursing Facility/Intermediate Care Facility
- Conway, SC
- NPI 1750466223
-
- General Acute Care Hospital
- Conway, SC
- NPI 1134172000
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1293062400000",
"number": "1891750782",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 50760",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295790013",
"telephone_number": "843-234-5139",
"fax_number": "843-234-6822"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8002 MYRTLE TRACE DR",
"city": "CONWAY",
"state": "SC",
"postal_code": "295268945",
"telephone_number": "843-347-7227"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JOHN",
"middle_name": "WINKLE",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-20",
"last_updated": "2010-12-23",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "SC",
"license": "3974",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "039746",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GP4505",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Conway, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.