Theodore Eugene Wyman, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

A104884 Issued in CA

Practice address

3579 Arlington Ave Ste 300
Riverside, CA 92506-3915

Phone

(951) 341-9333

Fax

(951) 341-9330

NPI assigned

Jul 8, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/EIHDCD/Endpoint/EIHDCD
• Direct secure messaging: theodore.wyman@3856.securemail.prognocis.com

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

• Neighborhood Healthcare

  • Federally Qualified Health Center (FQHC)
  • Escondido, CA
  • NPI 1598703647

  General Practice

  Medicare reassignment NPD
• Neighborhood Healthcare

  • Federally Qualified Health Center (FQHC)
  • Beaumont, CA
  • NPI 1629601653

  General Practice

  NPD

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

{
    "created_epoch": "1278547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718236800000",
    "number": "1083926919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3579 ARLINGTON AVE STE 300",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063915",
            "telephone_number": "951-341-9333",
            "fax_number": "951-341-9330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3579 ARLINGTON AVE STE 300",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063915",
            "telephone_number": "951-341-9333",
            "fax_number": "951-341-9330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYMAN",
        "first_name": "THEODORE",
        "middle_name": "EUGENE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-08",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "CA",
            "license": "A104884",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "A104884",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leslie Wu
• Christopher Don Wyatt, LCSW
• Katherine Wyatt, NP
• Wylie Center - a Psychological Corporation
• Mary Lukens Wyman, LCSW
• Lucas Ryan Wymore, MD
• Joanne T. Wyszomirski-Witkowski, MD
• Novanh Scott Xayarath, MFT
• Xia L.Liu Professional Dental Corp
• Wei Xia, DC

• General Practice Physician in Riverside, CA
• Providers in Riverside, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.