NPIMap

Individual provider Active NPI

Jared K Wilson, M.D.

  • Family Medicine Physician
  • Liberty, KY
National Provider Identifier
1902876667
Registry record updated Nov 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
32177 Issued in KY
Practice address
112 Liberty SQ
Liberty, KY 42539-3392
Phone
(606) 787-5044
Fax
(606) 787-5029
NPI assigned
Jan 25, 2006
Last updated
Nov 30, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 32177 KY Primary

Addresses

Primary practice location

112 Liberty SQ
Liberty, KY 42539-3392

Mailing address

112 Liberty SQ
Liberty, KY 42539-3392
Phone (606) 787-5044

Other identifiers 1

IdentifierTypeStateIssuer
64321771MedicaidKY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080226000200 KY Practitioner - Family PracticePractitioner - Emergency Medicine 5496646390 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine
Education
University of Louisville School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Casey County Hospital DistrictGroup PAC ID 0749193423, 9 clinicians
Champion Physical Therapy Kentucky, LLCGroup PAC ID 3476818519, shared by 3 NPIs, 43 clinicians

Practice addresses (Care Compare)

199 Adams St
Liberty, KY 42539-3064
Phone (606) 787-5044

2835 S Hwy 27
Suite 286B
Somerset, KY 42501-3062
Phone (606) 302-2831

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
69.66 of 100Reported as group
Quality
39.23
Promoting interoperability
99
Improvement activities
40
Cost
43.79

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
3477KYMDCase Manager/Care Coordinator
32177KYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Casey County Hospital District Current Accepting new patients
Casey County Hospital District CurrentSince Nov 3, 2014 Accepting new patients
Casey County Hospital District CurrentSince Nov 3, 2014 Accepting new patients
Medical Point of Care PLLC Family Medicine Past Accepting new patients
Westlake Regional Hospital Medical Group Past Accepting new patients
Casey County Hospital District Past Accepting new patients
Marshall Emergency Services Associates, PLLC Past Accepting new patients

Locations

112 Liberty Sq
Liberty, KY 42539
Phone (606) 787-5044

187 Wolford Ave
Liberty, KY 42539
Phone (606) 787-5044

199 Adams St
Liberty, KY 42539
Phone (606) 787-5044

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/caseyco-4151b385

Organizations & group practices 7

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.

Hospital & facility affiliations 6

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": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1448841600000",
    "number": "1902876667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 LIBERTY SQ",
            "city": "LIBERTY",
            "state": "KY",
            "postal_code": "425393392",
            "telephone_number": "606-787-5044",
            "fax_number": "606-787-5029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 LIBERTY SQ",
            "city": "LIBERTY",
            "state": "KY",
            "postal_code": "425393392",
            "telephone_number": "606-787-5044",
            "fax_number": "606-787-5029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JARED",
        "middle_name": "K",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-25",
        "last_updated": "2015-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "32177",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64321771",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Liberty, KY

Sources for this page

Verify at the official NPI Registry.