Jdee Ryan Wilson, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

M9137 Issued in ID

Practice address

700 E Alice St
State Hospital South
Blackfoot, ID 83221

Phone

(208) 785-1200

Fax

(208) 785-8516

NPI assigned

Dec 18, 2006

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 ID

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Mental Health Specialists

  • Clinical Social Worker
  • Chubbuck, ID
  • NPI 1548585458
  Medicare reassignment NPD
• Portneuf Valley Family Center

  • Professional Counselor
  • Pocatello, ID
  • NPI 1174629976

  Psychiatry

  NPD (past)

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1598828816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 E ALICE ST",
            "address_2": "STATE HOSPITAL SOUTH",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "83221",
            "telephone_number": "208-785-1200",
            "fax_number": "208-785-8516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 E ALICE ST",
            "address_2": "STATE HOSPITAL SOUTH",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "83221",
            "telephone_number": "208-785-1200",
            "fax_number": "208-785-8516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JDEE",
        "middle_name": "RYAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "ID",
            "license": "M9137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jan Cherie Williams, MPT
• Pamela Sue Williams, DO
• Tiffany Ann Williams, FNP-C
• Jan Williamson, RD,LD
• Abby Jan Wilson, FNP-BC, RD, CDCES
• Patricia Joyce Wolfley, M.S., CCC-SLP
• Sharee Julett Wolfley
• David Woodbury, PA
• Meghan L Woolstenhulme
• Jared Worthington, DDS

• Psychiatry Physician in Blackfoot, ID
• Providers in Blackfoot, ID by specialty
• Psychiatry Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.