Samuel M Wilson, DO - Medicare Dermatology in Roosevelt, UT

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Samuel M Wilson, DO is a medicare enrolled "Dermatology" physician in Roosevelt, Utah. He went to Edward Via Col Of Osteo Medicine-virginia Campus and graduated in 2010 and has 14 years of diverse experience with area of expertise as Dermatology. He is a member of the group practice Uintah Basin Medical Center, Northeastern Utah Medical Group and his current practice location is 210 W 300 N, Roosevelt, Utah. You can reach out to his office (for appointments etc.) via phone at (435) 722-4691.

Samuel M Wilson is licensed to practice in Utah (license number 5131797-1204) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1477865194.

Contact Information

Samuel M Wilson, DO
210 W 300 N,
Roosevelt, UT 84066-2336
(435) 722-4691
(435) 722-9291

Map and Direction




Physician's Profile

Full NameSamuel M Wilson
GenderMale
SpecialityDermatology
Experience14 Years
Location210 W 300 N, Roosevelt, Utah
Accepts Medicare AssignmentsYes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Samuel M Wilson attended and graduated from Edward Via Col Of Osteo Medicine-virginia Campus in 2010
  NPI Data:
  • NPI Number: 1477865194
  • Provider Enumeration Date: 07/10/2010
  • Last Update Date: 11/02/2021
  Medicare PECOS Information:
  • PECOS PAC ID: 4880841956
  • Enrollment ID: I20210826001828

Medical Identifiers

Medical identifiers for Samuel M Wilson such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1477865194NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207N00000XDermatology 5131797-1204 (Utah)Primary
207N00000XDermatology OP60440339 (Washington)Secondary

Medical Facilities Affiliation

Facility NameLocationFacility Type
Uintah Basin Medical CenterRoosevelt, UTHospital

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Uintah Basin Medical Center024413194456
Northeastern Utah Medical Group296149660942

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Samuel M Wilson allows following entities to bill medicare on his behalf.
Entity NameUintah Basin Medical Center
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1871556217
PECOS PAC ID: 0244131944
Enrollment ID: O20040226000948
Entity NameNortheastern Utah Medical Group
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1982664199
PECOS PAC ID: 2961496609
Enrollment ID: O20040414000471

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Samuel M Wilson is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Samuel M Wilson, DO
210 W 300 N,
Roosevelt, UT 84066-2336

Ph: (435) 725-7448		Samuel M Wilson, DO
210 W 300 N,
Roosevelt, UT 84066-2336

Ph: (435) 722-4691

Reviews and Comments


Dermatology Doctors in Roosevelt, UT

Dr. John S Blake, MD
Dermatology
Medicare: Accepting Medicare Assignments
Practice Location: 210 W 300 N 7-3, Roosevelt, UT 84066
Phone: 435-722-3971    Fax: 435-722-6104

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.