William Le Roy Wilson, M.D.

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

G44872 Issued in CA

Practice address

5565 Grossmont Center Dr
BLDG. 3, Suite 540
La Mesa, CA 91942-3020

Phone

(619) 460-2700

Fax

(619) 460-2702

NPI assigned

Sep 13, 2005

Reactivated

Apr 4, 2006

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

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: wwilson81751@scrippshlth.medalliesdirect.net
• Direct secure messaging: wwilson@pspc.curemd.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Scripps Health

  dba Scripps Hospital Medical Services

  • General Acute Care Hospital
  • San Diego, CA
  • NPI 1487928891
  NPD
• William L. Wilson, M.D., Inc.

  dba California Pain and Spine Care

  • Interventional Pain Medicine Physician
  • La Mesa, CA
  • NPI 1568424687
  NPD
• Pacific Coast Psychiatric Associates Inc

  dba Lifestance Health

  • Clinical Psychologist
  • Scottsdale, AZ
  • NPI 1023125465
  NPD (past)

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

{
    "created_epoch": "1126569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614297600000",
    "number": "1972598316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5565 GROSSMONT CENTER DR",
            "address_2": "BLDG. 3, SUITE 540",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919423020",
            "telephone_number": "619-460-2700",
            "fax_number": "619-460-2702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5565 GROSSMONT CENTER DR",
            "address_2": "BLDG. 3, SUITE 540",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919423020",
            "telephone_number": "619-460-2700",
            "fax_number": "619-460-2702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "WILLIAM",
        "middle_name": "LE ROY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-13",
        "last_updated": "2021-02-26",
        "certification_date": "2021-02-26",
        "deactivation_date": "2006-03-25",
        "reactivation_date": "2006-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "CA",
            "license": "G44872",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G448720",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrew Ryan Willis, PHARMD
• Whitney Layne Willis, MSW, LCSW
• Cameron W Wilson, MD
• Nicole Wilson
• Saranne J Wilson, LMFT
• Debra Marie Wimer
• Judi Logan Winegar, LCSW
• Wings Recovery Center, Inc.
• Wings Recovery Center, Inc.
• Wings Recovery Center, Inc.

• Interventional Pain Medicine Physician in La Mesa, CA
• Providers in La Mesa, CA by specialty
• Interventional Pain Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2021; 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.

Verify at the official NPI Registry.