SAMUEL M. WILSON (DO) – Dermatology Physician, NPI 1477865194
Dermatology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
393 DERMATOLOGY in WA
Provider Addresses for SAMUEL M. WILSON (DO)
1400 E KINCAID ST
ATTN: CREDENTIALING
MOUNT VERNON, WA 982744127
Phone: (360) 428-2500
Fax: (360) 428-6485
Type: Mailing
2320 FREEWAY DRIVE
SKAGIT REGIONAL CLINICS-RIVERBEND
MOUNT VERNON, WA 98273
Phone: (360) 814-6800
Fax: (360) 814-6917
Type: Location
210 W 300 N
ROOSEVELT, UT 840662336
Phone: (435) 722-4691
Fax: (435) 722-9291
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 8 Open Payments records for all available years, with a total value of $129.
Total Amount is formed as General ($129) + Research ($0) + Ownership ($0) = $129.
Last reported payment date: 2024-12-05 • Largest payer in this snapshot: Regeneron Healthcare Solutions, Inc. ($39).
Total Amount
$129
General + Research + Ownership
Payments
8
Total payment records
General Amount
$129
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-05
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Regeneron Healthcare Solutions, Inc. | $39 |
| ABBVIE INC. | $34 |
| Amgen Inc. | $27 |
| Lilly USA, LLC | $14 |
| E.R. Squibb & Sons, L.L.C. | $14 |
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: 2021-08-26
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20140905001841 | I | Dermatology | WA | TBD |
| I20210826001828 | I | Dermatology | UT | 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 |
|---|---|---|---|---|
| 17003 | Destruction of precancer skin growth, 2-14 growths | 811 | 149 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 271 | 195 | $0 |
| 17000 | Destruction of precancer skin growth, 1 growth | 237 | 194 | $0 |
| 11102 | Biopsy of related skin growth, first growth | 190 | 163 | $0 |
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 96 | 75 | $0 |
Insurance plans in this area (ZIP 98274)
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Provider's Procedures
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | UT | |
| Physician Assistant | UT | |
| General Surgery | UT | |
| Nurse Practitioner | UT | |
| H E M A T O L O G Y/ O N C O L O G Y | GA | |
| Medical Oncology, Hematology/Oncology, Internal Medicine | UT | |
| - | UT | |
| Internal Medicine | UT | |
| Physical Medicine And Rehabilitation | UT | |
| O T O L A R Y N G O L O G Y | CO |
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