DR. JACK T WILSON III D.M.D.
NPI 1396880902
Dentist - General Practice in Louisville, KY

Q: What is Jack Wilson Iii's NPI number?

The NPI number for Jack Wilson Iii is 1396880902. It was assigned to this individual provider in the NPPES registry on February 21, 2007.

Q: What is Jack Wilson Iii's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Q: When was this NPI record last updated?

The NPPES record for Jack Wilson Iii was last updated on July 8, 2007. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since February 21, 2007PECOS Enrolled

12010 SHELBYVILLE RD, SUITE 200, LOUISVILLE, KY 40243(502) 583-4771(502) 584-9922 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Dr. Jack T Wilson Iii D.m.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JACK T WILSON III D.M.D. (NPI 1396880902) is an individual general practice provider in Louisville, Kentucky, licensed in Kentucky (5247) and active in the NPI registry since February 2007. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1396880902

Entity TypeIndividualMale

Primary Taxonomy1223G0001X

Provider Legal NameDR. JACK T WILSON IIICredential: D.M.D.

Location Address12010 SHELBYVILLE RD, SUITE 200Louisville, KY 40243-1054

Mailing Address12010 Shelbyville Rd, Suite 200Louisville, KY 40243-1054 · (502) 583-4771 · Fax (502) 584-9922

Phone(502) 583-4771

Fax(502) 584-9922

Sole ProprietorYes

Enumeration DateFebruary 21, 2007

Last NPPES UpdateJuly 8, 2007

✔ NPI 1396880902 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

License✔ Licensed in KY · 5247

Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

12010 SHELBYVILLE RD, Louisville, KY 40243

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Other Identifiers 1

Other5247KY · Dentist - General Practit

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Jack T Wilson Iii D.m.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 40243 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$82.24 typical visit price

range $52.76 – $162.27

Typical copayment $20.56 (range $13.19 – $40.56)

Most-billed visit code 99203

Established Patient

$66.24 typical visit price

range $16.53 – $131.99

Typical copayment $16.56 (range $4.13 – $32.99)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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