MS. TINY BENITA WILSON FNP
NPI 1417029133
Nurse Practitioner - Family in Conyers, GA
About Ms. Tiny Benita Wilson Fnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MS. TINY BENITA WILSON FNP (NPI 1417029133) is an individual family provider in Conyers, Georgia, licensed in Georgia (RN135948NP) and active in the NPI registry since November 2006. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Ms. Tiny Benita Wilson Fnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Tiny Wilson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Dallas, TX 75244
- Reassigned Medicare billing, Georgia enrollment
- 488 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 30094 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Tiny Wilson's NPI number?
The NPI number for Tiny Wilson is 1417029133. It was assigned to this individual provider in the NPPES registry on November 15, 2006.
Where is Tiny Wilson located?
Tiny Wilson practices at 2890 Georgia Highway 212 SW Ste A360, Conyers, GA 30094. The listed phone number is (770) 601-6892.
What is Tiny Wilson's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Tiny Wilson enrolled in Medicare?
Yes. Tiny Wilson is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Tiny Wilson's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Tiny Wilson reassigns Medicare benefits to Signify Health Medical Associates, PLLC (Dallas, TX). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Tiny Wilson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Tiny Wilson accept?
Health plans from CareSource (Common Ground Healthcare) list Tiny Wilson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Tiny Wilson was last updated on June 20, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Ms. Tiny Benita Wilson, FNP · NPI 1417029133
Family physician in Conyers, Georgia. Individual provider, active in the CMS NPPES registry since November 15, 2006.
## Identity
- **NPI:** 1417029133 (Entity type: Individual)
- **Enumerated:** November 15, 2006
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** RN135948NP (Georgia)
- **Sole proprietor:** No
## Practice location
- **Address:** 2890 GEORGIA HIGHWAY 212 SW STE A360, Conyers, GA 30094
- **Phone:** (770) 601-6892
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Signify Health Medical Associates, PLLC (NPI 1750845863, Dallas, TX), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** June 20, 2018
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Source: [NPI Profile](https://npiprofile.com/npi/1417029133) · Data from the CMS NPPES public registry.