1. Home
  2. Directory
  3. Texas
  4. San Antonio
  5. Emergency Medicine
  6. NPI Profile

DR. THADDEUS DAVID WILSON M.D.
NPI 1417190869
Emergency Medicine in San Antonio, TX

Active since April 15, 2009PECOS Enrolled
4204 GARDENDALE ST, SUITE 312, SAN ANTONIO, TX 78229(210) 293-6003 Get Directions Write a Review

NPPES record last updated: February 21, 2019. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Dr. Thaddeus David Wilson M.d. NPPES

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

DR. THADDEUS DAVID WILSON M.D. (NPI 1417190869) is an individual emergency medicine provider in San Antonio, Texas, licensed in Tennessee (58235) and active in the NPI registry since April 2009. He is enrolled in Medicare PECOS and maintains a secondary practice location in Johnson City.

NPPES Registry Identity

NPI1417190869
Entity TypeIndividualMale
Primary Taxonomy207P00000X
Provider Legal NameDR. THADDEUS DAVID WILSONCredential: M.D.
Location Address4204 GARDENDALE ST, SUITE 312San Antonio, TX 78229-3132
Mailing Address4204 Gardendale St, Suite 312San Antonio, TX 78229-3132 · (210) 293-6003
Phone(210) 293-6003
Sole ProprietorNo
Enumeration DateApril 15, 2009
Last NPPES UpdateFebruary 21, 2019
✔ NPI 1417190869 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyEmergency MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207P00000X
License✔ Licensed in TN · 58235
Definition
An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.
Also ListedEmergency Medicine · Pediatric Emergency MedicineTaxonomy 207PP0204X · License Q4343 (TX)
4204 GARDENDALE ST, San Antonio, TX 78229
Open in Google Maps ↗

Secondary Practice Location 1

Location 1400 N State Of Franklin RdJohnson City, TN 37604-6035 · Phone (423) 431-6111

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Oscar Insurance Company.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Thaddeus David Wilson 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.

Medicare Billing Reassignment

Medicare enrollment records show Thaddeus Wilson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Tri-Cities Regional Emergency Physicians, PC
1,048 mi
Emergency Medicine
400 N STATE OF FRANKLIN RD
Johnson City, TN 37604
  • Reassigned Medicare billing, Tennessee enrollment
  • 284 clinicians in this Medicare group
NPI 1063950046 (423) 431-6111

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 78229 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
$84.92 typical visit price
range $54.84 – $166.88
Typical copayment $21.23 (range $13.71 – $41.72)
Most-billed visit code 99203
Established Patient
$97.05 typical visit price
range $17.52 – $136.11
Typical copayment $24.26 (range $4.38 – $34.02)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 17

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MARY C WATERMAN NP
Nurse Practitioner (Family)
4204 GARDENDALE ST, STE 312
SAN ANTONIO, TX 78229
Bexar County (210) 293-6006
CLAUDETTE L'ARMEE M.A., C.C.C.
Speech-Language Pathologist
4204 GARDENDALE ST, STE 206
SAN ANTONIO, TX 78229
Bexar County (210) 615-8484
JOHN G. DIMLER
Counselor (Professional)
4204 GARDENDALE ST, SUITE 203
SAN ANTONIO, TX 78229
Bexar County (210) 614-8452
MR. JOHN G DIMLER LPC, LCSW
Social Worker
4204 GARDENDALE ST, STE 203
SAN ANTONIO, TX 78229
Bexar County (210) 614-8452
DEVOUT HOME HEALTH, INC.
Home Health
4204 GARDENDALE ST, STE 212
SAN ANTONIO, TX 78229
Bexar County (210) 549-2986
DR. SEBRINA D PERKINS MD
Pediatrics (Pediatric Emergency Medicine)
4204 GARDENDALE ST, STE 312
SAN ANTONIO, TX 78229
Bexar County (210) 614-0180
MRS. RENNY SAMUEL-WORSHAM M.S.,R.D.,L.D.
Dietitian, Registered (Nutrition, Renal)
4204 GARDENDALE ST, STE 106
SAN ANTONIO, TX 78229
Bexar County (210) 325-0147
GREATER SAN ANTONIO EMERGENCY PHYSICIANS, PA
Emergency Medicine
4204 GARDENDALE ST, SUITE 312
SAN ANTONIO, TX 78229
Bexar County (210) 293-6006

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 Thaddeus Wilson's NPI number?

The NPI number for Thaddeus Wilson is 1417190869. It was assigned to this individual provider in the NPPES registry on April 15, 2009.

Where is Thaddeus Wilson located?

Thaddeus Wilson practices at 4204 Gardendale St Suite 312, San Antonio, TX 78229. The listed phone number is (210) 293-6003.

What is Thaddeus Wilson's specialty?

The primary specialty registered for this NPI is Emergency Medicine with taxonomy code 207P00000X.

Is Thaddeus Wilson enrolled in Medicare?

Yes. Thaddeus Wilson is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Thaddeus Wilson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Thaddeus Wilson reassigns Medicare benefits to Tri-Cities Regional Emergency Physicians, PC (Johnson City, TN). 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 Thaddeus Wilson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Thaddeus Wilson accept?

Health plans from Oscar Insurance Company list Thaddeus 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 Thaddeus Wilson was last updated on February 21, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.