Jill Mallory Fadal Wilson, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

10964555-1205 Issued in UT

Practice address

1389 Center Dr Ste 200
Park City, UT 84098-7660

Phone

(970) 484-4757

Fax

(970) 484-4759

NPI assigned

Mar 31, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other names 1

• Jill Mallory Fadal Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in UT, CO2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Diagnostic Radiology

Education

Texas Tech University Health Science Center School of Medicine, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Uchealth Imaging Services LLCGroup PAC ID 5799021291, 247 clinicians

Fort Collins Radiologic Associates PCGroup PAC ID 7315844396, 63 clinicians

University of Utah Adult ServicesGroup PAC ID 0941525273, 1,758 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Medical Center of the Rockies Hospital, Loveland, CO, CCN 060119
• Poudre Valley Hospital Hospital, Fort Collins, CO, CCN 060010
• Longs Peak Hospital Hospital, Longmont, CO, CCN 060128
• Uchealth Greeley Hospital Hospital, Greeley, CO, CCN 060131
• Ivinson Memorial Hospital Hospital, Laramie, WY, CCN 530025

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jfadal293251@direct.med.utah.edu

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.

• University of Utah Adult Services

  • General Practice Physician
  • Salt Lake City, UT
  • NPI 1114321981
  Medicare reassignment Care Compare group NPD
• Fort Collins Radiologic Associates PC

  • Diagnostic Radiology Physician
  • Fort Collins, CO
  • NPI 1003849498

  UT

  Medicare reassignment Care Compare group NPD
• Uchealth Imaging Services, LLC

  • Diagnostic Radiology Physician
  • Broomfield, CO
  • NPI 1396210902
  Medicare reassignment Care Compare group NPD
• University of Utah Adult Services

  • Infectious Disease Physician
  • Salt Lake City, UT
  • NPI 1033513833
  NPD
• University of Utah Adult Services

  • Diagnostic Radiology Physician
  • Salt Lake City, UT
  • NPI 1598169419
  NPD
• Uchealth Imaging Services, LLC

  • Diagnostic Radiology Physician
  • Highlands Ranch, CO
  • NPI 1043162142
  NPD
• Yampa Valley Medical Center

  • Multi-Specialty Clinic/Center
  • Steamboat Springs, CO
  • NPI 1295177426
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Ivinson Memorial Hospital

  • Rural Acute Care Hospital
  • Laramie, WY
  • NPI 1336289552
  Care Compare affiliation
• Longs Peak Hospital

  • General Acute Care Hospital
  • Longmont, CO
  • NPI 1154876985
  Care Compare affiliation
• Medical Center of the Rockies

  • General Acute Care Hospital
  • Greeley, CO
  • NPI 1104262286
  Care Compare affiliation
• Medical Center of the Rockies

  • General Acute Care Hospital
  • Loveland, CO
  • NPI 1750392304
  Care Compare affiliation
• Medical Center of the Rockies

  • General Acute Care Hospital
  • Greeley, CO
  • NPI 1780243055
  Care Compare affiliation
• Poudre Valley Health Care Inc

  • Clinic/Center
  • Fort Collins, CO
  • NPI 1457494304

  Hospital

  Care Compare affiliation
• Poudre Valley Health Care Inc

  • General Acute Care Hospital
  • Greeley, CO
  • NPI 1679419808
  Care Compare affiliation
• Poudre Valley Health Care Inc

  • General Acute Care Hospital
  • Greeley, CO
  • NPI 1962158857
  Care Compare affiliation
• Poudre Valley Health Care Inc.

  • General Acute Care Hospital
  • Fort Collins, CO
  • NPI 1073172094
  Care Compare affiliation
• Poudre Valley Health Care Inc.

  • General Acute Care Hospital
  • Fort Collins, CO
  • NPI 1093374001
  Care Compare affiliation
• Poudre Valley Health Care Inc.

  • General Acute Care Hospital
  • Fort Collins, CO
  • NPI 1093374092
  Care Compare affiliation
• Poudre Valley Health Care Inc.

  • General Acute Care Hospital
  • Fort Collins, CO
  • NPI 1114586278
  Care Compare affiliation

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

{
    "created_epoch": "1427760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709510400000",
    "number": "1275928897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2008 CARIBOU DR",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805254325",
            "telephone_number": "970-484-4757",
            "fax_number": "970-484-4759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1389 CENTER DR STE 200",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840987660",
            "telephone_number": "970-484-4757",
            "fax_number": "970-484-4759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JILL",
        "middle_name": "MALLORY FADAL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-31",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WY",
            "license": "15751A",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CO",
            "license": "DR.0070579",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "UT",
            "license": "10964555-1205",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NE",
            "license": "35561",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jfadal293251@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JILL",
            "last_name": "FADAL",
            "middle_name": "MALLORY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Perry Williams, DPT
• Shabrittany Williams, LPTA
• Stuart Eliot Willick, MD
• Celeste Annette Willmann-Chafin, LPTA
• Dodiann R Wilson, LPC
• Katherine Wilson
• Michelle Hill Wilson, MD
• Patricia K Winkelman, D.C.
• Robert T Winn, M.D.
• Amanda Jane Wissler, LCSW

• Diagnostic Radiology Physician in Park City, UT
• Providers in Park City, UT by specialty
• Diagnostic Radiology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2024; 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.