Dakota Wilson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-2347 Issued in ID

Practice address

1950 E Clark St
Pocatello, ID 83201-3314

Phone

(208) 232-7246

NPI assigned

Jun 10, 2022

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 ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mountain View Hospital LLCGroup PAC ID 4486562774, 272 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Portneuf Medical Center Hospital, Pocatello, ID, CCN 130028

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Mountain View Hospital LLC

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1669462362
  Medicare reassignment Care Compare group NPD
• Mountain View Hospital Physician Organization

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1073834529
  NPD (past)
• Ideal Option, PLLC

  • Clinic/Center
  • Kennewick, WA
  • NPI 1457788275
  NPD (past)

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

• Pocatello Hospital LLC

  • Rehabilitation Hospital Unit
  • Pocatello, ID
  • NPI 1144262114
  Care Compare affiliation
• Pocatello Hospital LLC

  • General Acute Care Hospital
  • Pocatello, ID
  • NPI 1790751055
  Care Compare affiliation

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

{
    "created_epoch": "1654819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664150400000",
    "number": "1992435234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 E CLARK ST",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832013314",
            "telephone_number": "208-232-7246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 E CLARK ST",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832013314",
            "telephone_number": "208-232-7246"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "921 S 8th Ave Stop 8253",
            "address_purpose": "LOCATION",
            "city": "Pocatello",
            "state": "ID",
            "postal_code": "832090002",
            "country_code": "US",
            "telephone_number": "208-282-4726",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "DAKOTA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-10",
        "last_updated": "2022-09-26",
        "certification_date": "2022-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-2347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara Willis
• Willow Counseling & Consulting LLC
• Silas Angier Wills Jr., MD
• Teri Lee Wilske, LSW
• Jessica Michelle Wilson-Lucero, ED.S, NCSP
• David Wilson, LCPC
• Jared Kent Wilson, PA-C, MPAS, MED, ATC
• Olivia Wilson
• Patricia Ann Wilson, CNIM
• Brianna Dannielle Windhorst, LPC

• Physician Assistant in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2022; 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.