NPIMap

Individual provider Active NPI

Nicholas Howard Wilson, PA-C

  • Physician Assistant
  • Oklahoma City, OK
National Provider Identifier
1902371222
Registry record updated Jul 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
3301 NW 50TH St
Oklahoma City, OK 73112-5627
Phone
(405) 947-0911
NPI assigned
Oct 12, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

3301 NW 50TH St
Oklahoma City, OK 73112-5627

Mailing address

14100 Parkway Commons Dr
Ste 101
Oklahoma City, OK 73134-6036
Phone (405) 463-3370

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190122002751 OK Practitioner - Physician Assistant 6305183815 Reassigns benefits to 1 organization
I20190416001559 TX Practitioner - Physician Assistant 6305183815 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthopedic Spine AssociatesGroup PAC ID 9931448008, 2 clinicians

Practice addresses (Care Compare)

14000 Pkwy Commons Dr
Suite a
Oklahoma City, OK 73134-6234
Phone (405) 463-3370

Hospital & facility affiliations

  • Oklahoma Center for Orthopaedic & Multi-SP Hospital, Oklahoma City, OK, CCN 370212
  • Lawton Indian Hospital Hospital, Lawton, OK, CCN 370170
  • Jackson County Memorial Hospital Authority Hospital, Altus, OK, CCN 370022
  • Mercy Hospital Oklahoma City, Inc Hospital, Oklahoma City, OK, CCN 370013
  • Summit Medical Center, LLC Hospital, Edmond, OK, CCN 370225

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2936OKMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Lawton Indian Hospital CurrentSince Apr 6, 2019 Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients
Summit Medical Center Past Accepting new patients

Locations

1515 NE Lawrie Tatum Rd
Lawton, OK 73507
Phone (580) 353-0350

Interoperability endpoints

  • Direct secure messaging: nicholas.wilson.2@19094.direct.athenahealth.com

Organizations & group practices 4

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.

Hospital & facility affiliations 10

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": "1539302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563840000000",
    "number": "1902371222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14100 PARKWAY COMMONS DR",
            "address_2": "STE 101",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731346036",
            "telephone_number": "405-463-3370",
            "fax_number": "405-463-3371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 NW 50TH ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731125627",
            "telephone_number": "405-947-0911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "NICHOLAS",
        "middle_name": "HOWARD",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-12",
        "last_updated": "2019-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.