Individual provider Active NPI

Stanley M Wilbur, M.D

  • Internal Medicine Physician
  • Parker, CO
National Provider Identifier
1942311378
Registry record updated Aug 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
G72614 Issued in CA
Practice address
12230 Lioness Way
Parker, CO 80134-5603
Phone
(720) 644-9355
Fax
(720) 523-1654
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X G72614 CA Primary

Addresses

Primary practice location

12230 Lioness Way
Parker, CO 80134-5603

Mailing address

12230 Lioness Way
Parker, CO 80134-5603
Phone (720) 644-9355

Other identifiers 1

IdentifierTypeStateIssuer
00G726140MedicaidCA

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20050429000122 CA Practitioner - Internal Medicine 5092754945 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Centro de Salud de la Comunidad de San Ysidro, Inc. CurrentSince Sep 14, 2024 Accepting new patients
Centro de Salud de la Comunidad de San Ysidro, Inc. Current Accepting new patients
Centro de Salud de la Comunidad de San Ysidro Inc CurrentSince Sep 14, 2024 Accepting new patients

Locations

880 Third Ave
#A
Chula Vista, CA 91911
Phone (619) 205-4585

1637 Third Ave
Ste B
Chula Vista, CA 91911
Phone (619) 425-1780

1136 D Ave
National City, CA 91950
Phone (619) 336-2300

1601 Precision Park Ln
San Ysidro, CA 92173
Phone (619) 205-4585

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.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629763200000",
    "number": "1942311378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12230 LIONESS WAY",
            "city": "PARKER",
            "state": "CO",
            "postal_code": "801345603",
            "telephone_number": "720-644-9355",
            "fax_number": "720-523-1654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12230 LIONESS WAY",
            "city": "PARKER",
            "state": "CO",
            "postal_code": "801345603",
            "telephone_number": "720-644-9355",
            "fax_number": "720-523-1654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILBUR",
        "first_name": "STANLEY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2021-08-24",
        "certification_date": "2021-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G72614",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G726140",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Parker, CO

Sources for this page

Verify at the official NPI Registry.