Active NPI
Matthew A Wilson, MD
- General Practice Physician
- Greenville, NC
National Provider Identifier
1962912253
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 0101266852
- Practice address
- 905 Johns Hopkins Dr
Greenville, NC 27834-2056 - Phone
- (252) 744-6683
- NPI assigned
- Oct 2, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 0101266852 | VA | Primary |
Addresses
Primary practice location
905 Johns Hopkins Dr
Greenville, NC 27834-2056
Mailing address
201 Avalon Ave
Muscle Shoals, AL 35661-2805
Phone (256) 768-8323
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171107000089 | NC | Order and Referring Only - Psychiatry | 1557627684 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101266852 | VA | MD | General Practice Physician |
Interoperability endpoints
- matthew.wilson.1@6239.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1506902400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714608000000",
"number": "1962912253",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 AVALON AVE",
"city": "MUSCLE SHOALS",
"state": "AL",
"postal_code": "356612805",
"telephone_number": "256-768-8323"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "905 JOHNS HOPKINS DR",
"city": "GREENVILLE",
"state": "NC",
"postal_code": "278342056",
"telephone_number": "252-744-6683"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "MATTHEW",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-10-02",
"last_updated": "2024-05-02",
"certification_date": "2024-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "VA",
"license": "0101266852",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2024; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.