Active NPI
Javon Wilson
- Other Technician
- Detroit, MI
National Provider Identifier
1912510918
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- Practice address
- 400 Renaissance Ctr Ste 2600
Detroit, MI 48243-1502 - Phone
- (855) 832-6727
- NPI assigned
- Aug 28, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Technician/Technologist | 156F00000X | |||
| Case Manager/Care Coordinator | 171M00000X | |||
| Other Technician | 247200000X | Primary |
Addresses
Primary practice location
400 Renaissance Ctr Ste 2600
Detroit, MI 48243-1502
Mailing address
7108 S Kanner Hwy
Stuart, FL 34997-7462
Other practice location 1
24200 Woodward Ave
Pleasant Ridge, MI 48069-1144
Phone (248) 547-2668
Other practice location 2
32100 Telegraph Rd Ste 205
Bingham Farms, MI 48025-2454
Phone (248) 712-4266
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624406400000",
"number": "1912510918",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7108 S KANNER HWY",
"city": "STUART",
"state": "FL",
"postal_code": "349977462"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 RENAISSANCE CTR STE 2600",
"city": "DETROIT",
"state": "MI",
"postal_code": "482431502",
"telephone_number": "855-832-6727"
}
],
"practiceLocations": [
{
"address_1": "24200 Woodward Ave",
"address_purpose": "LOCATION",
"city": "Pleasant Ridge",
"state": "MI",
"postal_code": "480691144",
"country_code": "US",
"telephone_number": "248-547-2668",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "32100 Telegraph Rd Ste 205",
"address_purpose": "LOCATION",
"city": "Bingham Farms",
"state": "MI",
"postal_code": "480252454",
"country_code": "US",
"telephone_number": "248-712-4266",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILSON",
"first_name": "JAVON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-08-28",
"last_updated": "2021-06-23",
"certification_date": "2021-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "156F00000X",
"taxonomy_group": "",
"desc": "Technician/Technologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.