Samuel G Wilson, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

G55580 Issued in CA

Practice address

12021 Jacaranda Ave
101
Hesperia, CA 92345-4956

Phone

(760) 956-5057

NPI assigned

Jun 9, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Emergency MedicineAlso: Family Practice, General Practice

Education

Loma Linda University School of Medicine, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• County of San Bernardino

  dba Department of Behavioral Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • San Bernardino, CA
  • NPI 1164467023
  Medicare reassignment NPD
• Faculty Physicians and Surgeons of Llusm

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Apple Valley, CA
  • NPI 1205009917
  Medicare reassignment NPD
• Chase Dennis Emergency Medical Group Inc

  • Emergency Medicine Physician
  • Santa Rosa, CA
  • NPI 1033152350
  Medicare reassignment
• County of San Bernardino

  dba Apple Valley Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Apple Valley, CA
  • NPI 1346950904
  NPD
• County of San Bernardino

  • Public Health or Welfare Agency
  • Ontario, CA
  • NPI 1588834451
  NPD
• Faculty Physicians and Surgeons of Llusm

  • Pediatrics Physician
  • San Bernardino, CA
  • NPI 1124077516
  NPD
• Faculty Physicians and Surgeons of Llusm

  • Family Medicine Physician
  • Moreno Valley, CA
  • NPI 1558788331
  NPD
• Faculty Physicians and Surgeons of Llusm

  • Pediatrics Physician
  • Highland, CA
  • NPI 1689624991
  NPD
• Community Health Emergency Medical Group Inc

  • Emergency Medicine Physician
  • Barstow, CA
  • NPI 1255379210
  NPD (past)
• Joshua Tree Emergency Physicians Medical Group, Inc

  • Emergency Medicine Physician
  • Blythe, CA
  • NPI 1649598632
  NPD (past)
• Keen Medical Group Inc

  • Occupational Health Nurse Practitioner
  • Hesperia, CA
  • NPI 1174901334
  NPD (past)
• Premier Emergency Physicians of California Medical Group PC

  • Emergency Medicine Physician
  • Barstow, CA
  • NPI 1225289135
  NPD (past)

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299110400000",
    "number": "1912948019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12021 JACARANDA AVE",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923454978",
            "telephone_number": "760-956-5057",
            "fax_number": "760-948-2179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12021 JACARANDA AVE",
            "address_2": "101",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923454956",
            "telephone_number": "760-956-5057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "SAMUEL",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2011-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "G55580",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "G55580",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G555800",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Takisha Williams, LCSW
• Willow Hospice Corporation
• Jeremy Wilson
• John Brant Wilson
• Madeleine Rae Wilson
• With Care Non-Emergency Medical Transport
• Aneya Wonders
• Dustin Wong, DO
• Sai Ho Wong, O.D.
• Audria Leann Woods

• Emergency Medicine Physician in Hesperia, CA
• Providers in Hesperia, CA by specialty
• Emergency Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2011; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.