NPIMap

Individual provider Active NPI

Michael Paul Wilson Jr., D.O.

  • Urology Physician
  • Middletown, NY
National Provider Identifier
1922489269
Registry record updated Jul 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
302827 Issued in NY
Practice address
707 E Main St
Middletown, NY 10940-2650
Phone
(845) 333-7575
Fax
(845) 333-7202
NPI assigned
Jun 12, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 302827 NY Primary

Addresses

Primary practice location

707 E Main St
Middletown, NY 10940-2650

Mailing address

707 E Main St
Middletown, NY 10940-2650
Phone (845) 333-7575

Other practice location 1

1 Medical Center Dr
Suite 162
Stratford, NJ 08084-1500
Phone (856) 566-6946

Other practice location 2

68 Harris Bushville Rd
Harris, NY 12742
Phone (845) 794-0996

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mwilson59873@direct.garnethealth.org Direct Garnet Health Doctors PC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210510002743 NY Practitioner - Urology 5890104590 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of New England, College of Osteo Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Amboy Medical Practice PCGroup PAC ID 2860538170, 171 clinicians

Practice addresses (Care Compare)

355 Bard Ave
Staten Island, NY 10310-1664

4434 Amboy Rd
Staten Island, NY 10312-3845
Phone (718) 984-9658

Hospital & facility affiliations

  • Richmond University Medical Center Hospital, Staten Island, NY, CCN 330028
  • NYU Langone Hospitals Hospital, New York, NY, CCN 330214

Merit-based Incentive Payment System (MIPS)

Final score
71.48 of 100Reported as apm
Quality
82.91
Promoting interoperability
5.67
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
302827NYMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Amboy Medical Practice PC Urology CurrentSince Jul 1, 2023 Accepting new patients
Amboy Medical Practice PC CurrentSince Jul 1, 2023 Accepting new patients
Richmond Medical Center Past Accepting new patients

Locations

4434 Amboy Rd
Staten Island, NY 10312
Phone (718) 818-1015

360 Bard Ave
Lowr
Staten Island, NY 10310
Phone (718) 818-2186

1200 South Ave
Ste 301
Staten Island, NY 10314
Phone (718) 370-1400

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: michael.wilson.1@19656.direct.athenahealth.com

Organizations & group practices 3

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1434067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626134400000",
    "number": "1922489269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 E MAIN ST",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109402650",
            "telephone_number": "845-333-7575",
            "fax_number": "845-333-7202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 E MAIN ST",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109402650",
            "telephone_number": "845-333-7575",
            "fax_number": "845-333-7202"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Medical Center Dr",
            "address_2": "Suite 162",
            "address_purpose": "LOCATION",
            "city": "Stratford",
            "state": "NJ",
            "postal_code": "080841500",
            "country_code": "US",
            "telephone_number": "856-566-6946",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "68 Harris Bushville Rd",
            "address_purpose": "LOCATION",
            "city": "Harris",
            "state": "NY",
            "postal_code": "12742",
            "country_code": "US",
            "telephone_number": "845-794-0996",
            "fax_number": "845-796-1404",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MICHAEL",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-12",
        "last_updated": "2021-07-13",
        "certification_date": "2021-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NY",
            "license": "302827",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mwilson59873@direct.garnethealth.org",
            "affiliation": "Y",
            "affiliationName": "Garnet Health Doctors PC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "707 E Main St",
            "city": "Middletown",
            "state": "NY",
            "country_code": "US",
            "postal_code": "109402650",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Middletown, NY

Sources for this page

Verify at the official NPI Registry.