Samuel M. Wilson, DO

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

5131797-1204 Issued in UT

Practice address

210 W 300 N
Roosevelt, UT 84066-2336

Phone

(435) 722-4691

Fax

(435) 722-9291

NPI assigned

Jul 10, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA, UT2 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

Dermatology

Education

Edward Via Col of Osteo Medicine-Virginia Campus, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Uintah Basin Medical CenterGroup PAC ID 0244131944, 62 clinicians

Northeastern Utah Medical GroupGroup PAC ID 2961496609, 52 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Uintah Basin Medical Center Hospital, Roosevelt, UT, CCN 460019

Merit-based Incentive Payment System (MIPS)

Final score

89.32 of 100Reported as apm

Quality

71.89

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• Northeastern Utah Medical Group

  • Family Medicine Physician
  • Roosevelt, UT
  • NPI 1982664199

  Dermatology

  Medicare reassignment Care Compare group NPD
• Uintah Basin Medical Center

  • General Acute Care Hospital
  • Roosevelt, UT
  • NPI 1871556217
  Medicare reassignment Care Compare group NPD
• Public Hospital Dist No 1 Skagit

  • General Practice Physician
  • Mount Vernon, WA
  • NPI 1023332749
  Medicare reassignment NPD
• Northeastern Utah Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Roosevelt, UT
  • NPI 1740482009
  NPD
• Uintah Basin Medical Center

  • Community/Retail Pharmacy
  • Vernal, UT
  • NPI 1285420414
  NPD
• Public Hospital Dist No 1 Skagit

  • Primary Care Clinic/Center
  • Granite Falls, WA
  • NPI 1033164470
  NPD
• Public Hospital Dist No 1 Skagit

  • Physical Therapist
  • Mount Vernon, WA
  • NPI 1811460652
  NPD

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

• Uintah Basin Medical Center

  • General Acute Care Hospital
  • Roosevelt, UT
  • NPI 1871556217
  Care Compare affiliation
• Uintah Basin Medical Center

  • General Acute Care Hospital
  • Vernal, UT
  • NPI 1881447571
  Care Compare affiliation
• Uintah Basin Medical Center

  • Physical Therapy Clinic/Center
  • Ballard, UT
  • NPI 1912750662

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1278720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635811200000",
    "number": "1477865194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 W 300 N",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "840662336",
            "telephone_number": "435-725-7448",
            "fax_number": "435-722-9291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 W 300 N",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "840662336",
            "telephone_number": "435-722-4691",
            "fax_number": "435-722-9291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "SAMUEL",
        "middle_name": "M.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-10",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "UT",
            "license": "5131797-1204",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "WA",
            "license": "OP60440339",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Lynn Wheeler, D.O.
• Brandon Lee White, D.C.
• James D White, MD
• Ben Douglas Williams, MD
• Jon Preston Wilson, O.D.
• Kaitlyn Winterton
• Audrie Christine Wisell, FNP
• Benjamin Zenger

• Dermatology Physician in Roosevelt, UT
• Providers in Roosevelt, UT by specialty
• Dermatology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2021; 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.