DR. JAMES WILSON MD
NPI 1467483750
Obstetrics & Gynecology - Gynecology in Ocean City, NJ
NPI Status: Active since July 05, 2006
- Individual
- Male
- Obstetrics & Gynecology
- Gynecology
- PECOS Enrolled
- Medicare Quality Reporting
About JAMES WILSON
This page provides the complete NPI Profile along with additional information for James Wilson, a women's health care provider established in Ocean City, New Jersey with a medical specialization in Obstetrics & Gynecology, focusing in gynecology . The healthcare provider is registered in the NPI registry with number 1467483750 assigned on July 2006. The practitioner's primary taxonomy code is 207VG0400X with license number MA040447 (NJ). The provider is registered as an individual and his NPI record was last updated 18 years ago.
- NPI
- 1467483750
- Provider Name
- DR. JAMES WILSON MD
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 213 WEST AVE OCEAN CITY, NJ 08226
- Location Phone
- (609) 399-0700
- Mailing Address
- PO BOX 366 OCEAN CITY, NJ 08226
- Mailing Phone
- (609) 399-0700
- Is Sole Proprietor?
- Yes
- Enumeration Date
- 07-05-2006
- Last Update Date
- 07-08-2007
- Code Navigator
Women's health care providers like James Wilson treat and diagnose diseases and conditions that affect a woman's physical and emotional health. Women's health professionals come from a variety of different specialties, including obstetrician/gynecologists, general surgeons, perinatologists, physician assistants, nurse practitioners or nurse midwives. A women's health provider might help you with family planning, breast care, pregnancy and child birth, osteoporosis, menopause, heart disease, etc.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Obstetrics & Gynecology Gynecology
- Taxonomy Code
- 207VG0400X
- Type
- Allopathic & Osteopathic Physicians
- License No.
- MA040447
- License State
- NJ
- Taxonomy Description
- A physician who specializes in diagnosis, treatment, and management of patients with gynecologic conditions. Source: National Uniform Claim Committee
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 456642 | OTHER (01) | NJ | AMERIHEALTH PP0 |
| 456642 | MEDICARE ID-TYPE UNSPECIFIED (04) | NJ | |
| 160019035 | OTHER (01) | NJ | MEDICARE RAILROAD |
| 2173000 | MEDICAID (05) | NJ | |
| PRUDENTIAL | OTHER (01) | NJ | 2225512321-00 |
| 577082 | OTHER (01) | NJ | OXFORD |
| D90431 | MEDICARE UPIN (02) | NJ | |
| 0105776000 | OTHER (01) | NJ | AMERIHEALTH HMO, POS |
| 1K1289 | OTHER (01) | NJ | HEALTHNET |
Medicare Participation & PECOS Enrollment Status
James Wilson is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes
Areas of Expertise
The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.
Established patient office or other outpatient visit, 30-39 minutes
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
This service was performed 53 times for 40 patientsPhysician Visit Costs
The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.
For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.
The prices below reflect the costs for new and established patients in the 08226 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99204
- Average New Patient Price $140.34
- Minimum New Patient Price $61.59
- Maximum New Patient Price $185.05
- Average New Patient Copayment $35.08
- Minimum New Patient Copayment $15.39
- Maximum New Patient Copayment $46.26
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99213
- Average Established Patient Price $76.45
- Minimum Established Patient Price $20.08
- Maximum Established Patient Price $150.98
- Average Established Patient Copayment $19.11
- Minimum Established Patient Copayment $5.02
- Maximum Established Patient Copayment $37.74
* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.
Quality Reporting
The provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.
| Quality Measure | Performance | Number of Patients |
|---|---|---|
| Documentation of Current Medications in the Medical Record | 100% | 438 |
| Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration | ||
| e-Prescribing | 99% | 352 |
| At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology. | ||
| Medication Reconciliation | 100% | 23 |
| The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician. | ||
| Patient-Specific Education | 99% | 274 |
| The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician. | ||
| Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan | 47% | 164 |
| Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter Normal Parameters: Age 18 years and older BMI >= 18.5 and < 25 kg/m2 | ||
| Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention | 13% | 116 |
| Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user | ||
| Provide 24/7 Access to MIPS Eligible Clinicians or Groups Who Have Real-Time Access to Patient's Medical Record | Yes | N/A |
| • Provide 24/7 access to MIPS eligible clinicians, groups, or care teams for advice about urgent and emergent care (e.g., MIPS eligible clinician and care team access to medical record, cross-coverage with access to medical record, or protocol-driven nurse line with access to medical record) that could include one or more of the following: • Expanded hours in evenings and weekends with access to the patient medical record (e.g., coordinate with small practices to provide alternate hour office visits and urgent care); • Use of alternatives to increase access to care team by MIPS eligible clinicians and groups, such as e-visits, phone visits, group visits, home visits and alternate locations (e.g., senior centers and assisted living centers); and/or Provision of same-day or next-day access to a consistent MIPS eligible clinician, group or care team when needed for urgent care or transition management. | ||
| Provide Patient Access | 74% | 274 |
| At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold certain information. | ||
| Security Risk Analysis | Yes | N/A |
| Conduct or review a security risk analysis in accordance with the requirements in 45 CFR 164.308(a)(1), including addressing the security (to include encryption) of ePHI data created or maintained by certified EHR technology in accordance with requirements in 45 CFR164.312(a)(2)(iv) and 45 CFR 164.306(d)(3), and implement security updates as necessary and correct identified security deficiencies as part of the MIPS eligible clinician's risk management process. | ||
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 4 | 6 | 7 | 4 | 8 | 3 | 7 | 5 | 0 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 4 | 12 | 7 | 8 | 8 | 6 | 7 | 10 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 4 + 1 + 2 + 7 + 8 + 8 + 6 + 7 + 1 + 0 + 24 = 70 | |||||||||
| Step 3: because the number obtained in step 2 ends in zero, the check digit is zero. | |||||||||
| 0 | |||||||||
The NPI number 1467483750 is valid because the calculated check digit 0 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 2 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1063787992 | ASSOCIATES IN WOMEN'S CARE, PA Organization | Obstetrics & Gynecology (Gynecology) | 213 WEST AVE OCEAN CITY, NJ 08226 (609) 399-0700 |
| 1083269492 | DR. SALLY SOBON WILSON DNP, MSN, AGNP-C, RN Individual | Nurse Practitioner (Primary Care) | 213 WEST AVE OCEAN CITY, NJ 08226 (609) 399-0700 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1467483750, enumerated in the NPI registry as an "individual" on July 05, 2006
The provider is located at 213 West Ave Ocean City, Nj 08226 and the phone number is (609) 399-0700
The provider's speciality is Obstetrics & Gynecology with taxonomy code 207VG0400X with a focus in Gynecology
The provider might be accepting Accepts: AmeriHealth, Medicare, Medicaid, Railroad Medicare. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
Medicare beneficiaries should expect a typical cost of $140.34 with an average copayment of $35.08 for new patient appointments. Established patients should expect a typical charge of $76.45 and an average copayment of 19.11. Please review your insurance plan or contact the provider directly to determine your specific costs.
The most common procedures or services performed by this practitioner are: Established patient office or other outpatient visit, 30-39 minutes.
This NPI record was last updated on July 05, 2006. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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