MS. DOMINIQUE RENEE WILSON (DNP, PMHNP, FNP) – Nurse Practitioner, NPI 1295019909
Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
22,204 NURSE PRACTITIONER in TX
Provider Addresses for MS. DOMINIQUE RENEE WILSON (DNP, PMHNP, FNP)
1380 RIVER BEND DR
DALLAS, TX 752474914
Phone: (214) 743-6159
Type: Mailing
401 Broadway Ste 100
Tacoma, WA 984023900
Phone: (855) 704-2004
Fax: (503) 386-3366
Type: Location
2000 E LaMar Blvd Ste 600
Arlington, TX 760067361
Phone: (855) 704-2004
Fax: (503) 386-3366
Type: Location
205 SE SPOKANE ST STE 300
PORTLAND, OR 972026487
Phone: (855) 704-2004
Fax: (503) 386-3366
Type: Mailing
PO BOX 541042
GRAND PRAIRIE, TX 750541042
Phone: (855) 704-2004
Fax: (817) 398-5609
Type: Mailing
4949 S MACADAM AVE STE 101A
PORTLAND, OR 972393912
Phone: (855) 704-2004
Fax: (817) 398-5609
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 3 Open Payments records for all available years, with a total value of $60.
Total Amount is formed as General ($60) + Research ($0) + Ownership ($0) = $60.
Last reported payment date: 2024-10-29 • Largest payer in this snapshot: Janssen Pharmaceuticals, Inc ($22).
Total Amount
$60
General + Research + Ownership
Payments
3
Total payment records
General Amount
$60
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-29
Latest reported date
Top Companies
Largest payers in this snapshot
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2021-06-15
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 3 Medicare enrollment records; no due dates published yet.
Enrollment records
3
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20120417000586 | I | Nurse Practitioner | TX | TBD |
| I20210422002882 | I | Nurse Practitioner | OR | TBD |
| I20210615002600 | I | Nurse Practitioner | WA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 90833 | Psychotherapy with evaluation and management visit, 30 minutes | 87 | 13 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 85 | 12 | $0 |
Insurance plans in this area (ZIP 75247)
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