Active NPI
Xavier Wilson
- Registered Dietitian
- Chicago, IL
National Provider Identifier
1982824264
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Practice address
- 2003 W Fulton St
Chicago, IL 60612-2345 - Phone
- (312) 850-3438
- NPI assigned
- Apr 27, 2007
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutritionist | 133N00000X | |||
| Nutrition Education Nutritionist | 133NN1002X | |||
| Registered Dietitian | 133V00000X | Primary |
Addresses
Primary practice location
2003 W Fulton St
Chicago, IL 60612-2345
Mailing address
832 Chancellor Ave
Irvington, NJ 07111
Phone (973) 399-6292
Other practice location 1
832 Chancellor Ave
Irvington, NJ 07111-2285
Phone (973) 399-6292
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 814644 | Other | NJ | ADA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1564099200000",
"number": "1982824264",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "832 CHANCELLOR AVE",
"city": "IRVINGTON",
"state": "NJ",
"postal_code": "07111",
"telephone_number": "973-399-6292",
"fax_number": "973-372-4534"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2003 W FULTON ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606122345",
"telephone_number": "312-850-3438"
}
],
"practiceLocations": [
{
"address_1": "832 Chancellor Ave",
"address_purpose": "LOCATION",
"city": "Irvington",
"state": "NJ",
"postal_code": "071112285",
"country_code": "US",
"telephone_number": "973-399-6292",
"fax_number": "973-372-4534",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILSON",
"first_name": "XAVIER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-27",
"last_updated": "2019-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": null,
"license": null,
"primary": false
},
{
"code": "133NN1002X",
"taxonomy_group": "",
"desc": "Nutritionist, Nutrition, Education",
"state": null,
"license": null,
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ADA",
"identifier": "814644",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.