Dr Samantha Dewitt Wilson, PSYD, LCSW is a medicare enrolled "Clinical Neuropsychologist" provider in San Diego, California. Her current practice location is
10085 Carroll Canyon Rd Ste 200h, San Diego, California. You can reach out to her office (for appointments etc.) via phone at
(858) 208-3463.
Dr Samantha Dewitt Wilson is licensed to practice in California (license number PSY34430) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1881823045.
Healthcare Provider's Profile
| Full Name | Dr Samantha Dewitt Wilson |
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| Gender | Female |
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| Speciality | Clinical Neuropsychologist |
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| Location | 10085 Carroll Canyon Rd Ste 200h, San Diego, California |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1881823045
- Provider Enumeration Date: 07/09/2009
- Last Update Date: 11/04/2024
Medicare PECOS Information:
- PECOS PAC ID: 4284090887
- Enrollment ID: I20230524003185
Medical Identifiers
Medical identifiers for Dr Samantha Dewitt Wilson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1881823045 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 103T00000X | Psychologist | 34430 (California) | Secondary |
| 1041C0700X | Social Worker - Clinical | 76389 (California) | Secondary |
| 103G00000X | Clinical Neuropsychologist | PSY34430 (California) | Primary |
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. Dr Samantha Dewitt Wilson allows following entities to bill medicare on her behalf.
| Entity Name | Adr Wellness, A Professional Psychology Corporation |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1073028742
PECOS PAC ID: 1456764216
Enrollment ID: O20210401000354 |
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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. Dr Samantha Dewitt 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 Address | Practice Location Address |
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Dr Samantha Dewitt Wilson, PSYD, LCSW
10085 Carroll Canyon Rd Ste 200h,
San Diego, CA 92131-1100
Ph: (858) 208-3463 | Dr Samantha Dewitt Wilson, PSYD, LCSW
10085 Carroll Canyon Rd Ste 200h,
San Diego, CA 92131-1100
Ph: (858) 208-3463 |
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