Angela Jeanine Wilson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

58950 Issued in CA

Practice address

2123 Ygnacio Valley Rd Ste K200
Walnut Creek, CA 94598-3336

Phone

(925) 926-0195

NPI assigned

Dec 24, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/24970/brand/1/csg/1/fhir/r4
• Direct secure messaging: angela.wilson@22525392.chartlogic.direct-ci.com

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.

• Action Urgent Care Inc

  • Urgent Care Clinic/Center
  • San Jose, CA
  • NPI 1205186442
  NPD (past)

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

{
    "created_epoch": "1608768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613779200000",
    "number": "1912594904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2123 YGNACIO VALLEY RD STE K200",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945983336",
            "telephone_number": "925-926-0195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2123 YGNACIO VALLEY RD STE K200",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945983336",
            "telephone_number": "925-926-0195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "ANGELA",
        "middle_name": "JEANINE",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-12-24",
        "last_updated": "2021-02-20",
        "certification_date": "2021-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "58950",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Willis
• Janae Willis
• Michelle Willis
• Robinson B Wills, P.T.
• Andrea Wilson, BCBA
• Laura Wilson, D.C.
• Mackenzie Wilson
• Michelle Wilson
• Montana E. Wilson
• Patricia Kaye Wilson

• Physician Assistant in Walnut Creek, CA
• Providers in Walnut Creek, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.