Peter Frederick Wilson, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1467 Issued in OR

Practice address

1217 NE Burnside Rd
BLDG B, Suite 401
Gresham, OR 97030-6722

Phone

(503) 666-8832

Fax

(503) 669-8641

NPI assigned

Sep 29, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Cornerstone Clinical Services PCGroup PAC ID 3274523378, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

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.

• Cornerstone Clinical Services PC

  • Community/Behavioral Health Agency
  • Milwaukie, OR
  • NPI 1093892895
  Medicare reassignment Care Compare group NPD
• Cornerstone Clinical Services, Inc

  • Community/Behavioral Health Agency
  • Lawton, OK
  • NPI 1184786238
  NPD
• Western Psychological and Counseling Services LLC

  • Clinical Psychologist
  • Vancouver, WA
  • NPI 1629345731
  NPD (past)

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1992897490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 82819",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972820819",
            "telephone_number": "503-233-5405",
            "fax_number": "503-233-2696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1217 NE BURNSIDE RD",
            "address_2": "BLDG B, SUITE 401",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970306722",
            "telephone_number": "503-666-8832",
            "fax_number": "503-669-8641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "PETER",
        "middle_name": "FREDERICK",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "1467",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "164936",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL MEDICARE #",
            "identifier": "131734",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shelley June Williams, REGISTERED NURSE
• Paul Willis
• Ryely Wilpone, MSW, LCSW
• Bethanie Wilson, CRM
• Natalie Dawn Wilson
• Henry Cooke Windell, DMD
• Georgann Dorthe Wingerson, MPA
• Kristi Winn, FNP
• Brandon Winward
• Paytonn Taini Wirt

• Clinical Psychologist in Gresham, OR
• Providers in Gresham, OR by specialty
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.