Omotezi Wilson, APN is a medicare enrolled "Nurse Practitioner - Psychiatric/mental Health" physician in Voorhees, New Jersey. Her current practice location is
443 Laurel Oak Rd Ste 130, Voorhees, New Jersey. You can reach out to her office (for appointments etc.) via phone at
(856) 857-6920.
Omotezi Wilson is licensed to practice in New Jersey (license number 26NJ14848500) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1912686338.
Physician's Profile
Full Name | Omotezi Wilson |
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Gender | Female |
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Speciality | Nurse Practitioner - Psychiatric/mental Health |
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Location | 443 Laurel Oak Rd Ste 130, Voorhees, New Jersey |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1912686338
- Provider Enumeration Date: 07/13/2023
- Last Update Date: 08/18/2023
Medicare PECOS Information:
- PECOS PAC ID: 6901268465
- Enrollment ID: I20240709002099
Medical Identifiers
Medical identifiers for Omotezi Wilson such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1912686338 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
2084P0800X | Psychiatry & Neurology - Psychiatry | 26NJ14848500 (New Jersey) | Secondary |
363LP0808X | Nurse Practitioner - Psychiatric/mental Health | 26NJ14848500 (New Jersey) | Primary |
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. Omotezi Wilson allows following entities to bill medicare on her behalf.
Entity Name | Kennedy Medical Group Practice, P.c. |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1952726796 PECOS PAC ID: 2860616877 Enrollment ID: O20140613000689 |
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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. Omotezi 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 |
Omotezi Wilson, APN 443 Laurel Oak Rd Ste 130, Kirkwood, NJ 08043-4419 Ph: (856) 857-6920 | Omotezi Wilson, APN 443 Laurel Oak Rd Ste 130, Voorhees, NJ 08043-4419 Ph: (856) 857-6920 |
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