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DR. MICHELLE BERGMANN WILSON DDS
NPI 1104026483
Dentist - General Practice in Centralia, WA

Active since July 24, 2007Opted out of Medicare · through Nov 14, 2027
1611 KRESKY AVE, SUITE 118, CENTRALIA, WA 98531(360) 736-1114 Get Directions Write a Review

NPPES record last updated: July 10, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Michelle Bergmann Wilson Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. MICHELLE BERGMANN WILSON DDS (NPI 1104026483) is an individual general practice provider in Centralia, Washington, licensed in Washington (DE00011026) and active in the NPI registry since July 2007. She has opted out of Medicare through November 14, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1104026483
Entity TypeIndividualFemale
Primary Taxonomy1223G0001X
Provider Legal NameDR. MICHELLE BERGMANN WILSONCredential: DDS
Location Address1611 KRESKY AVE, SUITE 118Centralia, WA 98531-8982
Mailing Address1611 Kresky Ave, Suite 118Centralia, WA 98531-8982 · (360) 736-1114
Phone(360) 736-1114
Sole ProprietorNo
Enumeration DateJuly 24, 2007
Last NPPES UpdateJuly 10, 2008
✔ NPI 1104026483 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in WA · DE00011026
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
1611 KRESKY AVE, Centralia, WA 98531
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Michelle Bergmann Wilson Dds has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from November 14, 2017 through November 14, 2027.

Opt-Out Effective DateNovember 14, 2017
Opt-Out In Effect ThroughNovember 14, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 98531 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$88.29 typical visit price
range $57.27 – $172.80
Typical copayment $22.07 (range $14.31 – $43.20)
Most-billed visit code 99203
Established Patient
$71.29 typical visit price
range $18.56 – $141.11
Typical copayment $17.82 (range $4.64 – $35.27)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. CHRISTIAN PATRICK WILSON D.D.S.
Dentist (General Practice)
1611 KRESKY AVE, SUITE 118
CENTRALIA, WA 98531
Lewis County (360) 736-1114
DR. BART C TIRRELL D.D.S., M.S.D., P.S.
Dentist (Endodontics)
1611 KRESKY AVE, SUITE 110
CENTRALIA, WA 98531
Lewis County (360) 807-0703
DR. FLOYD D SMITH M.D.
Internal Medicine
1611 KRESKY AVE, SUITE 112
CENTRALIA, WA 98531
Lewis County (360) 330-2023
DR. JOSHUA D BLUME D.C.
Chiropractor
1611 KRESKY AVE, SUITE 108
CENTRALIA, WA 98531
Lewis County (360) 330-1800
KIDS DENTAL OF CENTRALIA, P.C.
Dentist (General Practice)
1611 KRESKY AVE
CENTRALIA, WA 98531
Lewis County (360) 736-5437
FLOYD D SMITH, MD, INTERNAL MEDICINE, PS
Clinic/Center (Medical Specialty)
1611 KRESKY AVE, SUITE 112
CENTRALIA, WA 98531
Lewis County (360) 330-2023

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Michelle Wilson's NPI number?

The NPI number for Michelle Wilson is 1104026483. It was assigned to this individual provider in the NPPES registry on July 24, 2007.

Where is Michelle Wilson located?

Michelle Wilson practices at 1611 Kresky Ave Suite 118, Centralia, WA 98531. The listed phone number is (360) 736-1114.

What is Michelle Wilson's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Is Michelle Wilson enrolled in Medicare?

No. Michelle Wilson has opted out of Medicare through November 14, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Michelle Wilson was last updated on July 10, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.