Dr. Ian Jermaine Wilson
Radiology (Diagnostic Radiology)

Address: 1892 Winton Rd S Ste 190, Rochester, NY 14618-3996
Phone: 5859020444

Dr. Ian Jermaine Wilson (NPI# 1871793570) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider Identifier (NPI) 1871793570
Entity Type Individual
Full Name Dr. Ian Jermaine Wilson
Credential M.D.
Gender Male
Practice Address 1892 Winton Rd S Ste 190
NY 14618-3996
Practice Telephone 5859020444
Practice Fax Number 5854175513
Mailing Address 1892 Winton Rd S Ste 190
NY 14618-3996
Mailing Telephone 5859020444
Mailing Fax Number 5854175513
Sole Proprietor Yes, this individual is a Sole Proprietor
Enumeration Date 2007-07-20
Last Update Date 2018-03-17

Taxonomy Codes

Primary Taxonomy Classification Taxonomy Group License Number State
Yes 2085R0202X Radiology · Diagnostic Radiology Allopathic & Osteopathic Physicians 244637 NY
No 2085R0204X Radiology · Vascular & Interventional Radiology Allopathic & Osteopathic Physicians 244637 NY

Other Provider Identifier

State Identifier Issuer Type Code
NY 02933948 MEDICAID

Secondary Practice Locations

Address Telephone Number Fax Number
601 Elmwood Ave, Rochester, NY 146420001 5852751381 5852731003

Providers with the same name

NPI Name Taxonomy Address Enumeration
1750729216 Ian William Wilson Licensed Practical Nurse 2141 Crotona Ave, Apt. 2b, Bronx, NY 10457-2705 2013-06-06
1730484858 Ian Thomas Wilson Counselor 1600 E Olive St, Sound Mental Health, Seattle, WA 98122-2735 2011-01-20
1568781615 Ian Glen Wilson Behavior Analyst 6400 Tupelo Dr, Citrus Heights, CA 95621-1741 2010-05-27
1023238243 Ian Fitzsimmons Wilson Surgery 10000 Bay Pines Blvd, Baypines, FL 33744 2007-04-27
1760598239 Ian J Wilson Internal Medicine 625 Africa Rd Ste 200, Westerville, OH 43082 2006-08-21

Physician Overview

NPI 1871793570
PAC ID by PECOS 6305935388
Professional Enrollment ID I20071128000388
Full Name Ian Jermaine Wilson
Phone Number 5852752734
Gender M
Graduation Year 1999
Group Practice PAC ID 6800700170
Number of Group Practice Members 64
Accepts Medicare Assignment Y
Report Quality Measures Y
Use Electronic Health Records Y

Claims Based Hospital Affiliation

Claim Control Number (CCN) Legal Business Name

Taxonomy Information

Taxonomy Code 2085R0202X
Grouping Allopathic & Osteopathic Physicians
Classification Radiology
Specialization Diagnostic Radiology

Taxonomy Definition

A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source]
- Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1306333109 John Warren Kirby Radiology 200 1st St Sw # 507284, Rochester, MN 55905 2018-04-17
1235687088 Jeffery E. Illman Radiology 1082 Southern Ridge Dr Sw, Rochester, MN 55902-1854 2016-09-21
1518209675 Peter Alan Dvorak Radiology 36 Edgemont Rd, Rochester, NY 14620-4520 2013-03-26
1144519992 Daniel C Oppenheimer Radiology 601 Elmwood Ave Box 648, Rochester, NY 14642-1016 2011-04-01
1992094072 Joel P Thompson Radiology 995 Senator Keating Blvd Ste 100, Rochester, NY 14618-2777 2011-03-29
1487860482 Nadia Fatima Yusaf Radiology 2623 South Clinton Ave, Rochester, NY 14618-2623 2007-05-15
1356413470 Man-mei Nadine Su Radiology 1776 11th Ave Ne, Rochester, MN 55906-4215 2006-11-14
1639184377 Arun Basu Radiology 601 Elmwood Ave # 648, Rochester, NY 14642-0001 2006-07-30
1811901135 Devang Butani Radiology 601 Elmwood Ave / Univ. of Roch. Med Ctr, Imaging Sciences, Box 648, Rochester, NY 14642-1698 2006-07-29
1801822853 Michael Joseph Johnston Radiology 102 Elton Hills Dr Nw, Rochester, MN 55901-3562 2006-06-23
Find all providers in ROCHESTER

Office Location

Street Address 1892 WINTON RD S STE 190
State NY
Zip Code 14618-3996

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1760047278 Inner Power Physical Therapy Pllc Clinic/Center 2561 Lac Deville Boulevard, Suite 100, Rochester, NY 14618 2019-05-09
1659859858 Steven Sanfilippo Counselor 2000 S. Winton Rd., Building 4, Suite 303, Rochester, NY 14618 2018-07-31
1578064853 Feet First Inc Durable Medical Equipment & Medical Supplies 1900 Clinton Ave S Ste 5, Rochester, NY 14618 2018-02-22
1275057572 Walgreen Co Durable Medical Equipment & Medical Supplies 3349 Monroe Ave Ste 40, Rochester, NY 14618 2017-07-28
1558805374 Jennifer Virella Social Worker 2000 South Winton Road, Bldg 2, Rochester, NY 14618 2016-12-13
1235589300 Andrew Cyrus Marcy Nurse Practitioner 95 Allens Creek Road Bld 1 Ste 306, Rochester, NY 14618 2016-06-20
1932561073 Legacy Pediatrics Pediatrics 1815 South Clinton Avenue Ste 360, Rochester, NY 14618 2016-03-28
1790143105 Marie Lynn Bieber Dietitian, Registered 919 Winton Rd S Ste 220, Rochester, NY 14618 2016-02-01
1720443096 Brittany Rose Masetta Marriage & Family Therapist 2000 S Winton Rd, Bldg 4, Suite #200, Rochester, NY 14618 2015-12-30
1437543097 Kathleen Skye Whitbread Internal Medicine 2400 S Clinton Ave Ste G2, Rochester, NY 14618 2015-03-22
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Zip Code 14618

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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