Dominique Wilson

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Practice address

11185 Lake Blvd Ste 205
Chisago City, MN 55013-9814

Phone

(952) 228-3487

NPI assigned

Feb 14, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Fairview Express CareGroup PAC ID 3375645179, 1,946 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Fairview Express Care

  • Multi-Specialty Clinic/Center
  • Minneapolis, MN
  • NPI 1053952606

  MN

  Medicare reassignment Care Compare group NPD
• Fairview Health Services

  • Emergency Medicine Physician
  • Minneapolis, MN
  • NPI 1811077175

  MN

  Medicare reassignment NPD
• Healtheast Medical Research Institute

  • Clinic/Center
  • Vadnais Heights, MN
  • NPI 1639125503

  MN

  Medicare reassignment NPD
• Fairview Express Care

  • General Practice Physician
  • Edina, MN
  • NPI 1831707207
  Care Compare group NPD
• Fairview Express Care

  • Cardiovascular Disease Physician
  • Minneapolis, MN
  • NPI 1629224258
  Care Compare group
• Fairview Express Care

  • Eyewear Supplier
  • Eagan, MN
  • NPI 1750833562
  Care Compare group
• Fairview Express Care

  • Eyewear Supplier
  • Brooklyn Park, MN
  • NPI 1841472644
  Care Compare group
• Fairview Express Care

  • Eyewear Supplier
  • Andover, MN
  • NPI 1861674665
  Care Compare group
• Fairview Express Care

  • Eyewear Supplier
  • Fridley, MN
  • NPI 1942482740
  Care Compare group
• Fairview Express Care

  • Clinic/Center
  • Hudson, WI
  • NPI 1467159210
  Care Compare group
• Fairview Express Care

  • Clinic/Center
  • Forest Lake, MN
  • NPI 1386872281
  NPD
• Fairview Health Services

  • General Acute Care Hospital
  • Minneapolis, MN
  • NPI 1013994359
  NPD

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

{
    "created_epoch": "1644796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644796800000",
    "number": "1083369490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17566 XINGU ST NE",
            "city": "COLUMBUS",
            "state": "MN",
            "postal_code": "550258869",
            "telephone_number": "651-276-5894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11185 LAKE BLVD STE 205",
            "city": "CHISAGO CITY",
            "state": "MN",
            "postal_code": "550139814",
            "telephone_number": "952-228-3487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "DOMINIQUE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-14",
        "last_updated": "2022-02-14",
        "certification_date": "2022-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Heather@oakhaven-counseling.com",
            "affiliation": "N",
            "address_1": "11185 Lake Blvd Ste 205",
            "city": "Chisago City",
            "state": "MN",
            "country_code": "US",
            "postal_code": "550139814",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Total Eye Care LLC
• Transit Plus LLC
• Trio Wolf Creek Distance Learning Charter School
• Rachel Weiher
• Kevin William Welp, COTA
• Noelle Josephine Wilson, BKIN, MSCPT, DPT
• Steven A Zimmer, OD
• Carrolle Ann Zvonar, D.C.
• Michael Stephen Zvonar III, D.C.

• All providers in Chisago City, MN
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.