Randal Todd Wilson, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

D-4526 Issued in ID

Practice address

1309 Bennett Ave
Burley, ID 83318-2676

Phone

(208) 677-5198

NPI assigned

Aug 21, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Todd Wilson Other name

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: randal.wilson.p1@direct.fhsid.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Health Services Corporation

  dba Family Health Services

  • Federally Qualified Health Center (FQHC)
  • Buhl, ID
  • NPI 1003862525

  Dentist

  NPD (past)
• Family Health Services Corporation

  • Federally Qualified Health Center (FQHC)
  • Twin Falls, ID
  • NPI 1124571815

  Dentist

  NPD (past)
• Family Health Services Corporation

  dba Family Health Services

  • Federally Qualified Health Center (FQHC)
  • Twin Falls, ID
  • NPI 1235279217

  Dentist

  NPD (past)
• Family Health Services Corporation

  • Federally Qualified Health Center (FQHC)
  • Shoshone, ID
  • NPI 1841932498
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1377043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615939200000",
    "number": "1063846459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "794 EASTLAND DR",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833016856",
            "telephone_number": "208-734-3312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1309 BENNETT AVE",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833182676",
            "telephone_number": "208-677-5198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "RANDAL",
        "middle_name": "TODD",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-08-21",
        "last_updated": "2021-03-17",
        "certification_date": "2021-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D-4526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TODD",
            "last_name": "WILSON",
            "credential": "DMD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• James Whitmore, CRNA
• Gregory Brent Wilding, PHARMD
• Tamara Wilkinson, LCSW
• Carrie Inez Williams, OD
• April N Wilson, PHARM D
• Susie Kay Winder, MS, CCC-SLP
• Carol Winn Gonzales
• Amber A Winnett, PHARM D
• Wolverine Hearing Group, LLC
• Isaac Brent Woodward, DPT, PT

• Dentist in Burley, ID
• Providers in Burley, ID by specialty
• Dentist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.