DR. JARELL LAMONZ WILSON D.D.S.
NPI 1336694116
Dentist - Pediatric Dentistry in Peridot, AZ

Q: What is Jarell Wilson's NPI number?

The NPI number for Jarell Wilson is 1336694116. It was assigned to this individual provider in the NPPES registry on August 22, 2016.

Q: What is Jarell Wilson's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Pediatric Dentistry, with taxonomy code 1223P0221X.

Q: When was this NPI record last updated?

The NPPES record for Jarell Wilson was last updated on June 12, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months 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.

Active since August 22, 2016PECOS Enrolled

103 MEDICINE WAY RD, PERIDOT, AZ 85542(928) 475-1495 Get Directions Write a Review

NPPES record last updated: June 12, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Feb 25, 2020, Dec 11, 2018, Sep 15, 2016 and 1 more (4 updates tracked since 2016).

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About Dr. Jarell Lamonz Wilson D.d.s. NPPES

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

DR. JARELL LAMONZ WILSON D.D.S. (NPI 1336694116) is an individual pediatric dentistry provider in Peridot, Arizona, licensed in Arizona (D010564) and active in the NPI registry since August 2016. He is enrolled in Medicare PECOS and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1336694116

Entity TypeIndividualMale

Primary Taxonomy1223P0221X

Provider Legal NameDR. JARELL LAMONZ WILSONCredential: D.D.S.

Location Address103 MEDICINE WAY RDPeridot, AZ 85542-5000

Mailing Address360 S Mellonville AveSanford, FL 32771-1453 · (843) 593-5905

Phone(928) 475-1495

Sole ProprietorYes

Enumeration DateAugust 22, 2016

Last NPPES UpdateJune 12, 20264 updates tracked since enumeration

NPPES CertifiedJune 12, 2026

✔ NPI 1336694116 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyDentist · Pediatric DentistryDental Providers

Taxonomy Code1223P0221X

Licenses✔ Licensed in AZ · D010564✔ Licensed in FL · DN31327

Definition

An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

Also ListedDentist · Dental Public HealthTaxonomy 1223D0001X · License D010564 (AZ)

Also ListedDentist · General PracticeTaxonomy 1223G0001X · License 059461 (NY)

103 MEDICINE WAY RD, Peridot, AZ 85542

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Secondary Practice Locations 2

Location 11934 E Camelback Rd Ste 110Phoenix, AZ 85016-4136 · Phone (602) 833-2564

Location 2360 S Mellonville AveSanford, FL 32771-1453 · Phone (480) 492-1059

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Anthem Blue Cross and Blue Shield, BEST Life and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Jarell Lamonz Wilson D.d.s. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Jarell Wilson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

San Carlos Apache Healthcare Corporation

0.8 mi

Critical Access Hospital

103 MEDICINE WAY ROAD
Peridot, AZ 85542

Reassigned Medicare billing, Texas enrollment
438 clinicians in this Medicare group

NPI 1265813075 (928) 475-1200

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 85542 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

$85.89 typical visit price

range $55.44 – $168.60

Typical copayment $21.47 (range $13.86 – $42.15)

Most-billed visit code 99203

Established Patient

$69.24 typical visit price

range $17.72 – $137.41

Typical copayment $17.31 (range $4.43 – $34.35)

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 20

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

AMANDA HUBER

Dietitian, Registered