Dr Theodore Ernest Wilson, MD is a medicare enrolled "Medical Genetics - Clinical Genetics (m.d.)" physician in Indianapolis, Indiana. His current practice location is
550 University Blvd, Indianapolis, Indiana. You can reach out to his office (for appointments etc.) via phone at
(317) 944-3966.
Dr Theodore Ernest Wilson is licensed to practice in Indiana (license number 01079354A) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1699035030.
Physician's Profile
| Full Name | Dr Theodore Ernest Wilson |
|---|
| Gender | Male |
|---|
| Speciality | Medical Genetics - Clinical Genetics (m.d.) |
|---|
| Location | 550 University Blvd, Indianapolis, Indiana |
|---|
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
|---|
NPI Data:
- NPI Number: 1699035030
- Provider Enumeration Date: 05/18/2012
- Last Update Date: 09/26/2023
Medicare PECOS Information:
- PECOS PAC ID: 0941438568
- Enrollment ID: I20171031002674
Medical Identifiers
Medical identifiers for Dr Theodore Ernest Wilson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1699035030 | NPI | - | NPPES |
| 068010411 | Other | IN | MEDICARE PTAN |
| 300007251 | Medicaid | IN | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 208000000X | Pediatrics | P27658 (Maryland) | Secondary |
| 207SG0201X | Medical Genetics - Clinical Genetics (m.d.) | 01079354A (Indiana) | Primary |
| 208000000X | Pediatrics | 01079354A (Indiana) | Secondary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Theodore Ernest Wilson allows following entities to bill medicare on his behalf.
| Entity Name | University Family Physicians, Inc. |
|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
|---|
| Entity Identifiers | NPI Number: 1043275787
PECOS PAC ID: 7911992797
Enrollment ID: O20040420000393 |
|---|
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Theodore Ernest Wilson is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Theodore Ernest Wilson, MD
250 N Shadeland Ave,
Indianapolis, IN 46219-4959
Ph: () - | Dr Theodore Ernest Wilson, MD
550 University Blvd,
Indianapolis, IN 46202-5149
Ph: (317) 944-3966 |
Reviews and Comments