Active NPI
Jonathan Rashied Wilson Jr., ED.D.
- Case Manager/Care Coordinator
- Philadelphia, PA
National Provider Identifier
1992392187
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- License
- Q3-0000199
- Practice address
- 6504 Elmwood Ave
Philadelphia, PA 19142-2817 - Phone
- (267) 232-8383
- NPI assigned
- Dec 22, 2020
- 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 |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | Q3-0000199 | DE | Primary |
Addresses
Primary practice location
6504 Elmwood Ave
Philadelphia, PA 19142-2817
Mailing address
6504 Elmwood Ave
Philadelphia, PA 19142-2817
Phone (267) 232-8383
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| Q3-0000199 | DE | MD | Case Manager/Care Coordinator |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fathership Foundation | Case Manager/Care Coordinator | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- In Home Supportive Care Agency
- Philadelphia, PA
- NPI 1811584022
Case Manager/Care Coordinator
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1608595200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1608595200000",
"number": "1992392187",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6504 ELMWOOD AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191422817",
"telephone_number": "267-232-8383"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6504 ELMWOOD AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191422817",
"telephone_number": "267-232-8383"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JONATHAN",
"middle_name": "RASHIED",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "ED.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-12-22",
"last_updated": "2020-12-22",
"certification_date": "2020-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "DE",
"license": "Q3-0000199",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.