Dennis Wildman, CSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

261828-3502 Issued in UT

Practice address

1515 N 400 E Ste 104
North Logan, UT 84341-7595

Phone

(435) 755-6061

Fax

(435) 755-6091

NPI assigned

Sep 6, 2022

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

Medicare fee-for-service enrollment

Enrolled in UT

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

Clinical Social Worker

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ora CounselingGroup PAC ID 8426491705, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Sunshine Terrace Foundation, Inc

  • Home Health Agency
  • Logan, UT
  • NPI 1588806780

  W-2 Managing Employee

  CMS ownership

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.

• Ora Counseling

  • Multi-Specialty Clinic/Center
  • Logan, UT
  • NPI 1043810047

  UT

  Medicare reassignment Care Compare group NPD
• Ora Counseling

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Logan, UT
  • NPI 1285447433
  NPD
• Sunshine Terrace Foundation, Inc

  • Community Based Hospice Care Agency
  • Logan, UT
  • NPI 1326336892
  NPD (past)
• Medical Imaging Associates of Idaho Falls, Inc

  • Diagnostic Radiology Physician
  • Pocatello, ID
  • NPI 1740225531
  NPD (past)

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

{
    "created_epoch": "1662422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662422400000",
    "number": "1306567672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "517 W 100 N STE 210",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843329826",
            "telephone_number": "435-755-6061",
            "fax_number": "435-994-8362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 N 400 E STE 104",
            "city": "NORTH LOGAN",
            "state": "UT",
            "postal_code": "843417595",
            "telephone_number": "435-755-6061",
            "fax_number": "435-755-6091"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "120 S Main St",
            "address_purpose": "LOCATION",
            "city": "Randolph",
            "state": "UT",
            "postal_code": "840647701",
            "country_code": "US",
            "telephone_number": "435-755-6061",
            "fax_number": "435-994-3806",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "325 W Logan Rd",
            "address_purpose": "LOCATION",
            "city": "Garden City",
            "state": "UT",
            "postal_code": "840287754",
            "country_code": "US",
            "telephone_number": "435-946-3660",
            "fax_number": "435-946-8215",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5 W 200 N",
            "address_purpose": "LOCATION",
            "city": "Brigham City",
            "state": "UT",
            "postal_code": "843022109",
            "country_code": "US",
            "telephone_number": "435-723-7999",
            "fax_number": "435-723-7331",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "517 W 100 N Ste 110",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "UT",
            "postal_code": "843329826",
            "country_code": "US",
            "telephone_number": "435-755-6075",
            "fax_number": "435-374-0502",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILDMAN",
        "first_name": "DENNIS",
        "credential": "CSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-09-06",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "UT",
            "license": "261828-3502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in North Logan, UT
• Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; 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.