Individual provider Active NPI

Samantha Jayne Wilgus, DPM

  • Student in an Organized Health Care Education/Training Program
  • Greeley, CO
National Provider Identifier
1316793870
Registry record updated Apr 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
PDT.000632 Issued in CO
Practice address
1600 23Rd Ave
Greeley, CO 80634-6070
Phone
(970) 810-2847
Fax
(970) 810-2774
NPI assigned
Apr 25, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 29, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X PDT.000632 CO Primary

Addresses

Primary practice location

1600 23Rd Ave
Greeley, CO 80634-6070

Mailing address

1600 23Rd Ave
Greeley, CO 80634-6070
Phone (970) 810-2847

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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

Enrollment IDStateProvider typePAC IDDetails
I20250630001891 CO Order and Referring Only - PodiatryPractitioner - Podiatry 9638682040

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1714003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745884800000",
    "number": "1316793870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 23RD AVE",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806346070",
            "telephone_number": "970-810-2847",
            "fax_number": "970-810-2774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 23RD AVE",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806346070",
            "telephone_number": "970-810-2847",
            "fax_number": "970-810-2774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILGUS",
        "first_name": "SAMANTHA",
        "middle_name": "JAYNE",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-04-25",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CO",
            "license": "PDT.000632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greeley, CO

Sources for this page

Verify at the official NPI Registry.