TARA L WILSON (MD) – Surgery Physician, NPI 1720174345
Surgery Physician
Main info
Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
3,317 GENERAL SURGERY in CA
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Provider Addresses for TARA L WILSON (MD)
Corona, Avenida Carrera 15, UPZs de Bogotá, Localidad Chapinero, Bogota, Bogota, Capital District, RAP (Especial) Central, 110221, Colombia
CORONA, CA 928782828
Phone: (951) 278-8870
Fax: (951) 278-8913
Type: Mailing
3660, Park Sierra Drive, Riverside, Riverside County, California, 92505, United States
SUITE 105
RIVERSIDE, CA 925053071
Phone: (951) 278-8870
Fax: (951) 278-8913
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 5 Open Payments records for all available years, with a total value of $344.
Total Amount is formed as General ($344) + Research ($0) + Ownership ($0) = $344.
Last reported payment date: 2024-11-08 • Largest payer in this snapshot: Medtronic, Inc. ($315).
Total Amount
$344
General + Research + Ownership
Payments
5
Total payment records
General Amount
$344
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-08
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Medtronic, Inc. | $315 |
| AstraZeneca Pharmaceuticals LP | $30 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2007-03-07
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20070307000520 | I | General Surgery | CA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 92878)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| U R O L O G Y | OH | |
| Nurse Practitioner | CA | |
| Internal Medicine | CA | |
| Internal Medicine | CA | |
| Internal Medicine, Gastroenterology | CA | |
| Physician Assistant | CA | |
| Emergency Medicine | NC | |
| O P H T H A L M O L O G Y | CA | |
| Anesthesiology, Pain Management | NH | |
| Family Practice, Sports Medicine | CA |
Reviews
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