DR. JOHN DAVID WILSON (MD) – Family Medicine Physician, NPI 1104071224

DR. JOHN DAVID WILSON (MD) is a healthcare provider. based in Grants pass, Oregon. specializing in FAMILY PRACTICE. They hold the professional credentials MD. They hold a License No. MD37095 (TN). The NPI Number for DR. JOHN DAVID WILSON (MD) is 1104071224

Main info

Male
26 Years Of Experience
Accepts Medicare Assignment
Name
DR. JOHN DAVID WILSON (MD)
NPI
1104071224
Phone
(541) 476-6644
Address
495 SW RAMSEY AVE
Enumeration Date
18 November 2008
Last Update Date
6 July 2010

Doctor Profile

Medical School Name
LOMA LINDA UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
5414766644
Graduation Year
2000 (26 years ago)
PAC ID
0941284566
Group Practice PAC ID
9234123977
Professional Enrollment ID
I20100728000639
Address ID
OR975275681GR495XXAVEX400
Telehealth
Yes
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience62
Completeness75
Years active:17State licenses:2Digital endpointsOther names

2,081 FAMILY PRACTICE in OR

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Provider Addresses for DR. JOHN DAVID WILSON (MD)

  • 495, Ramsey Avenue, Grants Pass, Josephine County, Oregon, 97527, United States

    GRANTS PASS, OR 975275681

    Phone: (541) 476-6644

    Mailing address matches the actual address.

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: 2010-07-28

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
I20100728000639IFamily PracticeORTBD

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99214Established patient office or other outpatient visit, 30-39 minutes355197$0
36415Insertion of needle into vein for collection of blood sample342182$0
80053Blood test, comprehensive group of blood chemicals274172$0
80061Blood test, lipids (cholesterol and triglycerides)142138$0
G0439Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit137137$0
View full utilization report →

Insurance plans in this area (ZIP 97527)

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Provider's Procedures

DR. JOHN DAVID WILSON (MD) performs procedures in FAMILY PRACTICE. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
FAMILY MEDICINEOR85610Blood test, clotting time8824
FAMILY MEDICINEOR90670Pneumococcal vaccine for injection into muscle2020

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: 9234123977View full group profile
NameSpecialtyState
-OR
Physician AssistantOR
Family PracticeOR
Physician AssistantOR
Internal MedicineOR
Family PracticeGA
General SurgeryOR
P O D I A T R YOR
Internal MedicineOR
Nurse PractitionerOR

Reviews

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Frequently asked questions

What is the 10-digit NPI for DR. JOHN DAVID WILSON (MD)?
DR. JOHN DAVID WILSON (MD) — NPI 1104071224 — is the standard way to identify this listing.
Is DR. JOHN DAVID WILSON (MD) listed as active for patients and plans?
The listing shows DR. JOHN DAVID WILSON (MD) as active in the NPI system.
What healthcare role does DR. JOHN DAVID WILSON (MD) hold?
Scheduling teams often label DR. JOHN DAVID WILSON (MD) under Family Medicine Physician. Clinical services aligned with this taxonomy classification.
What area does DR. JOHN DAVID WILSON (MD) serve?
DR. JOHN DAVID WILSON (MD)'s listing highlights Grants Pass, Oregon; more addresses can appear in NPPES.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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