Individual provider Active NPI

Wyatt Ho, MD

  • Plastic Surgery Physician
  • Tucson, AZ
National Provider Identifier
1023245578
Registry record updated Mar 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
66380 Issued in AZ
Practice address
1104 N El Dorado PL
Tucson, AZ 85715-4606
Phone
(520) 762-9777
Fax
(520) 666-3211
NPI assigned
Jun 11, 2009
Last updated
Mar 12, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 66380 AZ
Plastic Surgery Physician 208200000X 66380 AZ Primary

Addresses

Primary practice location

1104 N El Dorado PL
Tucson, AZ 85715-4606

Mailing address

1104 N El Dorado PL
Tucson, AZ 85715-4606
Phone (520) 762-9777

Other identifiers 2

IdentifierTypeStateIssuer
200294390AMedicaidOK
128639MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230914001907 AZ Practitioner - Plastic and Reconstructive Surgery 5698075091 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
University of Arizona College of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1104 N El Dorado PL
Tucson, AZ 85715-4606
Phone (520) 762-9777

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
66380AZMDPlastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Arizona Plastic Surgery, PLLC Plastic Surgery CurrentSince Mar 13, 2025 Accepting new patients

Locations

1104 N El Dorado Pl
Tucson, AZ 85715
Phone (520) 745-5586

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1244678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741737600000",
    "number": "1023245578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1104 N EL DORADO PL",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857154606",
            "telephone_number": "520-762-9777",
            "fax_number": "520-666-3211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1104 N EL DORADO PL",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857154606",
            "telephone_number": "520-762-9777",
            "fax_number": "520-666-3211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HO",
        "first_name": "WYATT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-11",
        "last_updated": "2025-03-12",
        "certification_date": "2025-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AZ",
            "license": "66380",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "AZ",
            "license": "66380",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200294390A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "128639",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.