Wilson Nicolas Otero, M.D.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

MD00030353 Issued in WA

Practice address

9149 Estate Thomas
Paragon Medical Building Suite 208
St. Thomas, VI 00802-2615

Phone

(340) 714-1122

NPI assigned

Apr 30, 2007

Last updated

Mar 28, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 15

Medicare fee-for-service enrollment

Enrolled in NM, VI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lovelace Health System LLC

  • Clinic/Center
  • Santa Fe, NM
  • NPI 1245798024
  Medicare reassignment NPD
• Ariel Gastroenterology, P.a.

  • Specialist
  • Hialeah, FL
  • NPI 1225295892
  Authorized official Same address or phone
• Lovelace Health System LLC

  • Rural Health Clinic/Center
  • Roswell, NM
  • NPI 1609273283

  Family Medicine

  NPD
• Lovelace Health System, Inc.

  • Cardiovascular Disease Physician
  • Roswell, NM
  • NPI 1306238183
  NPD
• Lovelace Health System, LLC

  • Rural Health Clinic/Center
  • Roswell, NM
  • NPI 1164137964

  Family Medicine

  NPD
• Optumcare Endoscopy Center New Mexico, LLC

  dba DaVita Medical Endoscopy

  • Ambulatory Surgical Clinic/Center
  • Albuquerque, NM
  • NPI 1962685834
  NPD (past)

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

{
    "created_epoch": "1177891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679961600000",
    "number": "1992925051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12400 SW 1ST CT",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333252702",
            "telephone_number": "954-483-8335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9149 ESTATE THOMAS",
            "address_2": "PARAGON MEDICAL BUILDING SUITE 208",
            "city": "ST. THOMAS",
            "state": "VI",
            "postal_code": "008022615",
            "telephone_number": "340-714-1122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTERO",
        "first_name": "WILSON",
        "middle_name": "NICOLAS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-30",
        "last_updated": "2023-03-28",
        "certification_date": "2023-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AZ",
            "license": "44063",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "VI",
            "license": "3572",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "AZ",
            "license": "44063",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "WA",
            "license": "MD00030353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VISTA HEALTH PLAN ID #",
            "identifier": "59257",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA PPO ID NUMBER",
            "identifier": "020549565",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "040931600",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE PROVIDER ID #",
            "identifier": "28885",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVMED PROVIDER ID #",
            "identifier": "237645",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA HTLH INS ID #",
            "identifier": "020549565",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREPLUS  PROVIDER  ID #",
            "identifier": "1025558",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEMORIAL MANAGED CARE ID",
            "identifier": "104531",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STAYWELL HLTH PLANS ID #",
            "identifier": "28885",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEIGHBORHOOD HTLH PLAN ID",
            "identifier": "33648",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HTLHCARE ID #",
            "identifier": "020549565",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHEASE HLTH PLANS ID#",
            "identifier": "28885",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA NETWORK ID NUMBER",
            "identifier": "4073765",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD FL",
            "identifier": "96681",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "582847",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephen Okiye, MD
• Ermin E. Olive, M.S.,RD
• On the Go Physio
• On the Go Physio LLC
• Open Arms Adult Daycare & Respite Services, LLC
• Jenifer L Palacios
• Paradise Chiropractic and Wellness Center of STX
• Paradise Surgical, LLC
• Paragon Surgical Center, LLC
• Paramount Medical (Garfield A. Less, MD)

• Gastroenterology Physician in St Thomas, VI
• Providers in St Thomas, VI by specialty
• Gastroenterology Physician in U.S. Virgin Islands

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.