Individual provider Active NPI

Johnna McKelvey Wilson, D.O.

  • Pediatric Critical Care Medicine Physician
  • Newburgh, IN
National Provider Identifier
1912369182
Registry record updated Sep 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
02007225A Issued in IN
Practice address
4011 Gateway Blvd
Newburgh, IN 47630-8947
Phone
(812) 842-3880
Fax
(812) 842-3916
NPI assigned
Mar 25, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 8, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Critical Care Medicine Physician 2080P0203X 02007225A IN Primary
Pediatrics Physician 208000000X 125.068895 IL
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X 036148541 IL

Addresses

Primary practice location

4011 Gateway Blvd
Newburgh, IN 47630-8947

Mailing address

PO Box 632281
Cincinnati, OH 45263-2281
Phone (812) 450-6815

Other practice location 1

2160 S 1st Ave
Maywood, IL 60153-3328
Phone (708) 327-9124

Other names 1

  • Johnna McKelvey Sizemore Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230808002821 IN Practitioner - Pediatric Medicine 3375886096 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036148541ILMDPediatrics Physician
125.068895ILMDPediatrics Physician
02007225AINMDPediatric Critical Care Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Deaconess Hospital, Inc Multi-Specialty Current Accepting new patients
Deaconess Hospital Inc Multi-Specialty CurrentSince Aug 1, 2023 Accepting new patients
Deaconess Hospital, Inc Multi-Specialty CurrentSince Aug 1, 2023 Accepting new patients
Deaconess Hospital, Inc. Past Accepting new patients

Locations

600 Mary St
Evansville, IN 47710
Phone (812) 450-2239

4011 Gateway Blvd
Newburgh, IN 47630
Phone (812) 450-2240

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1458864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757289600000",
    "number": "1912369182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 632281",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452632281",
            "telephone_number": "812-450-6815",
            "fax_number": "812-450-6822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4011 GATEWAY BLVD",
            "city": "NEWBURGH",
            "state": "IN",
            "postal_code": "476308947",
            "telephone_number": "812-842-3880",
            "fax_number": "812-842-3916"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2160 S 1st Ave",
            "address_purpose": "LOCATION",
            "city": "Maywood",
            "state": "IL",
            "postal_code": "601533328",
            "country_code": "US",
            "telephone_number": "708-327-9124",
            "fax_number": "708-327-9132",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JOHNNA",
        "middle_name": "MCKELVEY",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-03-25",
        "last_updated": "2025-09-08",
        "certification_date": "2025-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "IN",
            "license": "02007225A",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "125.068895",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036148541",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOHNNA",
            "last_name": "SIZEMORE",
            "middle_name": "MCKELVEY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Newburgh, IN

Sources for this page

Verify at the official NPI Registry.