Matthew H. Wilson, PMH-NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R050669 Issued in ME

Practice address

12 Bolduc Ave
Fort Kent, ME 04743-1602

Phone

(207) 834-3971

Fax

(207) 834-3837

NPI assigned

Feb 15, 2007

Sex

Male

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 ME

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

Specialty

Nurse Practitioner

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fish River Rural HealthGroup PAC ID 3577531953, 21 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: matthew.wilson.1@10077.direct.athenahealth.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.

• Fish River Rural Health

  • Federally Qualified Health Center (FQHC)
  • Fort Kent, ME
  • NPI 1174741094
  Medicare reassignment Care Compare group NPD
• Fish River Rural Health

  • Federally Qualified Health Center (FQHC)
  • Van Buren, ME
  • NPI 1528608437
  NPD
• Fish River Rural Health

  • Federally Qualified Health Center (FQHC)
  • Fort Kent, ME
  • NPI 1568838928
  NPD

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

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642550400000",
    "number": "1962545343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 BOLDUC AVE",
            "city": "FORT KENT",
            "state": "ME",
            "postal_code": "047431602",
            "telephone_number": "207-834-3971",
            "fax_number": "207-834-3837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 BOLDUC AVE",
            "city": "FORT KENT",
            "state": "ME",
            "postal_code": "047431602",
            "telephone_number": "207-834-3971",
            "fax_number": "207-834-3837"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10 Carter St",
            "address_purpose": "LOCATION",
            "city": "Eagle Lake",
            "state": "ME",
            "postal_code": "047393060",
            "country_code": "US",
            "telephone_number": "207-444-5973",
            "fax_number": "207-444-5520",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "MATTHEW",
        "middle_name": "H.",
        "name_prefix": "Mr.",
        "credential": "PMH-NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-15",
        "last_updated": "2022-01-19",
        "certification_date": "2022-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "ME",
            "license": "R050669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Fort Kent, ME
• Providers in Fort Kent, ME by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2022; 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.