Wilson Mak, FNP
Individual provider Active NPI Family Nurse Practitioner · Modesto, CA
NPI 1922427665 · NPPES record last updated Apr 9, 2014
Key facts
- NPI
- 1922427665
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 95000312 (CA)
- Practice address
- 1114 6TH St
Modesto, CA 95354-2203 - Phone
- (209) 576-2845
- Fax
- (209) 576-8842
- NPI assigned
- Apr 9, 2014
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Carbon Health Primary Care of California PC
Practice addresses (Care Compare)
2712 Augustine Dr
Suite 120
Santa Clara, CA 95054-2941
Phone (408) 780-2542
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140605000432 | CA | Practitioner - Nurse Practitioner | 2961626304 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 812700 | CA | MD | Registered Nurse |
| 95000312 | CA | MD | Family Nurse Practitioner |
Practice roles (1 of 2)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of Santa Clara | Past | Accepting new patients |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 812700 | CA | |
| Family Nurse Practitioner | 363LF0000X | 95000312 | CA | Yes |
Addresses
Primary practice location
1114 6TH St
Modesto, CA 95354-2203
Mailing address
737 W Childs Ave
Credentialing Department
Merced, CA 95341-6805
Phone (209) 383-1848
Other providers in Modesto, CA
- Diana Helen Maida
- Lisa Marie Maitland
- Michael Majeski
- Shristi Majumdar
- Kenneth W Mak
- Elias Makhoul
- Lia Margaret Maksoud
- Damariz Malagon
- Gwenyth Halie Malcolm
- Anastashia Thalia Maldonado
All providers in Modesto, CA · Family Nurse Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 9, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.