NPIMap

Individual provider Active NPI

James Bradley Wilson Jr., DO

  • Family Medicine Physician
  • Clermont, FL
National Provider Identifier
1992747034
Registry record updated Aug 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS7986 Issued in FL
Practice address
17327 Pagonia Rd
Clermont, FL 34711-6009
Phone
(407) 905-6009
Fax
(407) 636-7849
NPI assigned
Jun 12, 2006
Last updated
Aug 5, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS7986 FL Primary

Addresses

Primary practice location

17327 Pagonia Rd
Clermont, FL 34711-6009

Mailing address

17327 Pagonia Rd
Clermont, FL 34711-6009
Phone (407) 905-6009

Other identifiers 1

IdentifierTypeStateIssuer
OS 7986OtherFLFLORIDA LISCENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101214000875 FL Practitioner - Family Practice 3779658448 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ability Health Services, IncGroup PAC ID 4082523329, 1,249 clinicians
Ability Health Services and Rehabilitation LPGroup PAC ID 4981986288, shared by 2 NPIs, 1,260 clinicians
Orlando Physicians Network IncGroup PAC ID 7719026251, 231 clinicians

Practice addresses (Care Compare)

1200 Lexington Green LN
Sanford, FL 32771-1013

21 Columbia St
Orlando, FL 32806-1133
Phone (321) 841-6600

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS7986FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orlando Health, Inc. Current Accepting new patients
Orlando Physicians Network Inc Family Medicine CurrentSince May 1, 2020 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Orlando Health Medical Group Inc Past Accepting new patients
South Lake Internal Medicine PA Past Accepting new patients
Central Florida Internists, Inc. Family Medicine Past Accepting new patients
Laurel Oaks Family Practice PA Family Medicine PastSince Feb 27, 2008 Accepting new patients

Locations

17319 Pagonia Rd
Ste 285
Clermont, FL 34711
Phone (407) 905-6009

17325 Pagonia Rd
Clermont, FL 34711
Phone (407) 905-6006

17327 Pagonia Rd
Clermont, FL 34711
Phone (407) 905-6000

21 Columbia St
Orlando, FL 32806
Phone (321) 841-5560

Interoperability endpoints

  • Direct secure messaging: jwilson25568@orlandohealth.medalliesdirect.net

Organizations & group practices 7

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.

Hospital & facility affiliations 9

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": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596585600000",
    "number": "1992747034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17327 PAGONIA RD",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347116009",
            "telephone_number": "407-905-6009",
            "fax_number": "407-636-7849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17327 PAGONIA RD",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347116009",
            "telephone_number": "407-905-6009",
            "fax_number": "407-636-7849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JAMES",
        "middle_name": "BRADLEY",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2020-08-05",
        "certification_date": "2020-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS7986",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA LISCENSE",
            "identifier": "OS 7986",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clermont, FL

Sources for this page

Verify at the official NPI Registry.