Bradley Russell Wilson, FNP in Detroit, MI - Medicare Nurse Practitioner

Bradley Russell Wilson, FNP is a medicare enrolled "Nurse Practitioner - Family" in Detroit, Michigan. His current practice location is 22101 Moross Rd, Detroit, Michigan. You can reach out to his office (for appointments etc.) via phone at (313) 343-3660.

Bradley Russell Wilson is licensed to practice in Michigan (license number 470429662) 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 1508339987.

Contact Information

	Bradley Russell Wilson, FNP
	22101 Moross Rd, Detroit, MI 48236-2148
	(313) 343-3660
	Not Available

Map and Direction

Provider's Profile

Full Name	Bradley Russell Wilson
Gender	Male
Speciality	Nurse Practitioner - Family
Location	22101 Moross Rd, Detroit, Michigan
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1508339987
Provider Enumeration Date: 01/08/2019
Last Update Date: 01/08/2019

Medicare PECOS Information:

PECOS PAC ID: 6305296864
Enrollment ID: I20231223000072

Medical Identifiers

Medical identifiers for Bradley Russell Wilson such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1508339987	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LF0000X	Nurse Practitioner - Family	470429662 (Michigan)	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. Bradley Russell Wilson allows following entities to bill medicare on his behalf.

Entity Name	Ascension St John Hospital
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1043478910 PECOS PAC ID: 3173424082 Enrollment ID: O20040115000409

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. Bradley Russell 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
Bradley Russell Wilson, FNP 36251 Alfred St, New Baltimore, MI 48047-2106 Ph: (586) 840-6016	Bradley Russell Wilson, FNP 22101 Moross Rd, Detroit, MI 48236-2148 Ph: (313) 343-3660

Reviews and Comments

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Bradley Russell Wilson, FNP - Medicare Nurse Practitioner in Detroit, MI