NPIMap

Individual provider Active NPI

Edith Diane Wilson, MD

  • Urology Physician
  • Olympia, WA
National Provider Identifier
1972602969
Registry record updated Aug 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
5500A Issued in WY
Practice address
615 Lilly Rd NE Ste 175
Olympia, WA 98506-5179
Phone
(360) 486-6772
Fax
(360) 486-6775
NPI assigned
Sep 22, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 5500A WY Primary
Urology Physician 208800000X 36402 CO

Addresses

Primary practice location

615 Lilly Rd NE Ste 175
Olympia, WA 98506-5179

Mailing address

615 Lilly Rd NE Ste 175
Olympia, WA 98506-5179
Phone (360) 486-6772

Other identifiers 2

IdentifierTypeStateIssuer
110601500MedicaidWY
W9209OtherCLINIC MCAR #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, CO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20151230002369 ND Practitioner - Urology 5294626008 Reassigns benefits to 1 organization
I20180626000496 CO Practitioner - Urology 5294626008 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

777 Bannock St
Denver, CO 80204-4507
Phone (303) 436-6000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.65 of 100Reported as group
Quality
92.15
Promoting interoperability
100
Improvement activities
40
Cost
80.02

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36402COMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Alexius Medical Center CurrentSince Dec 14, 2015 Accepting new patients
Denver Health and Hospital Authority CurrentSince Apr 29, 2019 Accepting new patients
St. Alexius Medical Center CurrentSince Dec 14, 2015 Accepting new patients
Denver Health and Hospital Authority CurrentSince Apr 29, 2019 Accepting new patients
Medi Horizons Inc Past Accepting new patients
Denver Health and Hospital Authority Past Accepting new patients

Locations

777 Bannock St
#3240
Denver, CO 80204
Phone (303) 602-2714

777 Bannock St
Ste MC3450
Denver, CO 80204

777 Bannock St
Denver, CO 80204

900 E Broadway Ave
Bismarck, ND 58501
Phone (701) 530-7300

Organizations & group practices 6

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 3

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": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314576000000",
    "number": "1972602969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 LILLY RD NE STE 175",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065179",
            "telephone_number": "360-486-6772",
            "fax_number": "360-486-6775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 LILLY RD NE STE 175",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065179",
            "telephone_number": "360-486-6772",
            "fax_number": "360-486-6775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "EDITH",
        "middle_name": "DIANE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-22",
        "last_updated": "2011-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "WY",
            "license": "5500A",
            "primary": true
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "CO",
            "license": "36402",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110601500",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLINIC MCAR #",
            "identifier": "W9209",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia, WA

Sources for this page

Verify at the official NPI Registry.