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SHANE MICHAEL WILSON
NPI 1659121952
Emergency Medicine in Columbia, SC

Active since March 27, 2024PECOS Enrolled
14 RICHLAND MEDICAL PARK DR STE 350, COLUMBIA, SC 29203(803) 434-1663(803) 434-7092 Get Directions Write a Review

NPPES record last updated: August 11, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Shane Michael Wilson NPPES

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

SHANE MICHAEL WILSON (NPI 1659121952) is an individual emergency medicine provider in Columbia, South Carolina, licensed in South Carolina (92795) and active in the NPI registry since March 2024. He is enrolled in Medicare PECOS, maintains a secondary practice location in Greenwood, and is a graduate of Other (2024).

NPPES Registry Identity

NPI1659121952
Entity TypeIndividualMale
Primary Taxonomy207P00000X
Provider Legal NameSHANE MICHAEL WILSON
Location Address14 RICHLAND MEDICAL PARK DR STE 350Columbia, SC 29203-6896
Mailing Address300 E Mcbee Ave Fl 4Greenville, SC 29601-2842
Phone(803) 434-1663
Fax(803) 434-7092
Sole ProprietorYes
Medical School CMSOtherGraduated 2024
Enumeration DateMarch 27, 2024
Last NPPES UpdateAugust 11, 2026
NPPES CertifiedAugust 11, 2026
✔ NPI 1659121952 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyEmergency MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207P00000X
License✔ Licensed in SC · 92795
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.
14 RICHLAND MEDICAL PARK DR STE 350, Columbia, SC 29203
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Secondary Practice Location 1

Location 11325 Spring StGreenwood, SC 29646-3860 · Phone (864) 725-4780

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Shane Michael Wilson is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID3476089285
PECOS Enrollment IDI20260529003555
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 Reassignments

2

Medicare enrollment records show Shane Wilson reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Prisma Health Medical Group-Midlands
0.1 mi
Orthopaedic Surgery
14 RICHLAND MEDICAL PARK DR STE 200
Columbia, SC 29203
  • Reassigned Medicare billing, South Carolina enrollment
  • 1,466 clinicians in this Medicare group
NPI 1346761897 (803) 296-9200
Self Medical Group
37 mi
Rural Health
2605 KINARD STREET, SUITE 200
Newberry, SC 29108
  • Reassigned Medicare billing, South Carolina enrollment
  • 560 clinicians in this Medicare group
NPI 1477880003 (803) 405-1900

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 29203 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
$83.18 typical visit price
range $53.57 – $163.84
Typical copayment $20.79 (range $13.39 – $40.96)
Most-billed visit code 99203
Established Patient
$95.12 typical visit price
range $16.96 – $133.52
Typical copayment $23.78 (range $4.24 – $33.38)
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 20

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

MICHAEL BULLOCK
Emergency Medicine
14 RICHLAND MEDICAL PARK DR STE 350
COLUMBIA, SC 29203
Richland County (803) 434-3790
BRIAN RIEHL
Physician Assistant
14 RICHLAND MEDICAL PARK DR STE 350
COLUMBIA, SC 29203
Richland County (803) 434-1663
MATTHEW STAUB MD
Emergency Medicine
14 RICHLAND MEDICAL PARK DR STE 350
COLUMBIA, SC 29203
Richland County (803) 434-3790
JENNIFER SHAYE LOWERY PA-C
Physician Assistant
14 RICHLAND MEDICAL PARK DR STE 350
COLUMBIA, SC 29203
Richland County (803) 434-1663
JACOB A MCKENNA
Emergency Medicine
14 RICHLAND MEDICAL PARK DR STE 350
COLUMBIA, SC 29203
Richland County (803) 434-3790
NOAH MINA
Emergency Medicine
14 RICHLAND MEDICAL PARK DR STE 350
COLUMBIA, SC 29203
Richland County (803) 434-1663
HALIE CARPENTER
Physician Assistant
14 RICHLAND MEDICAL PARK DR STE 350
COLUMBIA, SC 29203
Richland County (803) 434-1663
RITIELY DELEON DO
Family Medicine
14 RICHLAND MEDICAL PARK DR STE 350
COLUMBIA, SC 29203
Richland County (803) 434-1663

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 Shane Wilson's NPI number?

The NPI number for Shane Wilson is 1659121952. It was assigned to this individual provider in the NPPES registry on March 27, 2024.

Where is Shane Wilson located?

Shane Wilson practices at 14 Richland Medical Park Dr Ste 350, Columbia, SC 29203. The listed phone number is (803) 434-1663.

What is Shane Wilson's specialty?

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

Is Shane Wilson enrolled in Medicare?

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

Which organizations bill Medicare for Shane Wilson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Shane Wilson reassigns Medicare benefits to 2 organizations: Prisma Health Medical Group-Midlands (Columbia, SC) and Self Medical Group (Newberry, SC). Each 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 Shane Wilson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Shane Wilson was last updated on August 11, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months 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.