Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jacob Landis Wilson

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1396234670

Jacob Landis Wilson is an Obstetrics/Gynecology in Phoenix, Arizona. Graduated from University of Illinois College of Med (CHI/PEOR/ROCK/Chm-Urb) in 2018, 8 years ago. Practices with Southern California Permanente Medical Group, an 11,242-clinician group and accepts Medicare assignment.

Years since qualifying
8
Trained at
University of Illinois College of Med (CHI/PEOR/ROCK/Chm-Urb)
In the registry since
2018
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Practice location Address checks out

2601 E Roosevelt St
Phoenix, AZ 85008-4973
Phone: (602) 344-5084
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1396234670
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMay 2, 2018
Last updated in NPPESNovember 21, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOBSTETRICS/GYNECOLOGY
Medical schoolUNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
Graduated 2018 (8 years in practice)
Group practice Southern California Permanente Medical Group — 11242 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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