MARY A. WILSON (CRNA) – Certified Registered Nurse Anesthetist, NPI 1770599615

MARY A. WILSON (CRNA) is a healthcare provider. based in Rancho cucamonga, California. specializing in CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA). They hold the professional credentials CRNA. They hold a License No. NA 2575 (CA). The NPI Number for MARY A. WILSON (CRNA) is 1770599615

Main info

Female
27 Years Of Experience
Accepts Medicare Assignment
Name
MARY A. WILSON (CRNA)
NPI
1770599615
Phone
(909) 581-6400
Address
10841 WHITE OAK AVE
Enumeration Date
31 July 2006
Last Update Date
2 December 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9513532000
Graduation Year
1999 (27 years ago)
PAC ID
2769376268
Group Practice PAC ID
6002729175
Professional Enrollment ID
I20040213000156
Address ID
CA925053043RI10800AVEX300

Contacts

SOAP Endpoint
https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience52
Completeness85
Years active:19State licenses:1Other namesUpdated within 12 months

2,456 CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) in CA

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Provider Addresses for MARY A. WILSON (CRNA)

  • Kindred Hospital Rancho, 10841, White Oak Avenue, Rancho Cucamonga, San Bernardino County, California, 91730, United States

    RANCHO CUCAMONGA, CA 917303817

    Phone: (909) 581-6400

    Fax: (909) 581-6418

    Type: Location

  • North Tustin Avenue, Santa Ana, Orange County, California, 92705, United States

    SANTA ANA, CA 927053807

    Phone: (714) 347-1010

    Fax: (714) 647-1245

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

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: 2004-02-13

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20040213000156ICertified Registered Nurse Anesthetist (Crna)CATBD

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.

Verify on CMS Revalidation Lookup Tool

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 91730)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 6002729175View full group profile
NameSpecialtyState
U R O L O G YOH
Nurse PractitionerCA
Internal MedicineCA
Internal MedicineCA
Internal Medicine, GastroenterologyCA
Physician AssistantCA
Emergency MedicineNC
O P H T H A L M O L O G YCA
Anesthesiology, Pain ManagementNH
Family Practice, Sports MedicineCA

Reviews

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Frequently asked questions

What unique ID ties claims to MARY A. WILSON (CRNA)?
NPI 1770599615 is assigned to MARY A. WILSON (CRNA) under the national enumeration system.
Is MARY A. WILSON (CRNA)'s enrollment marked active?
An active flag here means the NPI record is not in a deactivated state.
What does MARY A. WILSON (CRNA) treat or focus on?
Patients typically see MARY A. WILSON (CRNA) under the specialty Certified Registered Nurse Anesthetist. Clinical services aligned with this taxonomy classification.
Where is MARY A. WILSON (CRNA)'s primary listing?
We display Rancho Cucamonga, California because that is what the record indicates for MARY A. WILSON (CRNA).
What if Rancho Cucamonga, California seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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