Alycia Julia Wirtz

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

101549 Issued in IA

Practice address

720 Kenyon Rd
Fort Dodge, IA 50501-5759

Phone

(800) 482-8305

NPI assigned

Dec 16, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IA

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

Medicare enrollment (NPD)

Enrolled

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.

• Humboldt County Memorial Hospital

  • Emergency Medicine Physician
  • Humboldt, IA
  • NPI 1043395247

  Mental Health

  Medicare reassignment NPD
• Humboldt County Memorial Hospital

  • Critical Access Hospital
  • Humboldt, IA
  • NPI 1194702977
  Medicare reassignment NPD
• North Central Iowa Mental Health Center Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fort Dodge, IA
  • NPI 1922188606
  Medicare reassignment NPD
• North Central Iowa Mental Health Center Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fort Dodge, IA
  • NPI 1801635404
  NPD

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

{
    "created_epoch": "1608076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608076800000",
    "number": "1447846167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 KENYON RD",
            "city": "FORT DODGE",
            "state": "IA",
            "postal_code": "505015759",
            "telephone_number": "800-482-8305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 KENYON RD",
            "city": "FORT DODGE",
            "state": "IA",
            "postal_code": "505015759",
            "telephone_number": "800-482-8305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIRTZ",
        "first_name": "ALYCIA",
        "middle_name": "JULIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-16",
        "last_updated": "2020-12-16",
        "certification_date": "2020-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IA",
            "license": "101549",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0159608",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUE SHIELD",
            "identifier": "07466",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.unitypoint.org/fortdodge/berryhill",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "720 Kenyon Rd",
            "city": "Fort Dodge",
            "state": "IA",
            "country_code": "US",
            "postal_code": "505015759",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Amanda Kathryn Wilson, RN, BSN, CNOR
• Grant Wilson, PA-C
• James Matthew Wilson, M.D.
• Michael David Wilson, DPM
• Savannah Meredith Wiltfang, DNAP, CRNA
• Amy Lynette Witham, MSW
• Breannon Wiuff
• Donna Ann Wong
• Alexis Lerae Woodley
• Emily Ann Wubben, ARNP

• Mental Health Counselor in Fort Dodge, IA
• Providers in Fort Dodge, IA by specialty
• Mental Health Counselor in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2020; 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.