Individual provider Active NPI

Wynton Campbell

  • Occupational Therapist
  • Addison, TX
National Provider Identifier
1104553767
Registry record updated Aug 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Practice address
5057 Keller Springs Rd Ste 150
Addison, TX 75001-6217
Phone
(800) 420-1036
NPI assigned
Aug 4, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X FL Primary

Addresses

Primary practice location

5057 Keller Springs Rd Ste 150
Addison, TX 75001-6217

Mailing address

5057 Keller Springs Rd Ste 150
Addison, TX 75001-6217
Phone (800) 420-1036

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220825000591 FL Practitioner - Occupational Therapist in Private Practice 9537543566 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
QRM Plus Florida - OT LLC Occupational Therapist CurrentSince Aug 1, 2022 Accepting new patients
Rehabcare Group East, LLC Past Accepting new patients

Locations

670 Flushing Ave
Ste 307
Brooklyn, NY 11206

5057 Keller Springs Rd
Ste 150
Addison, TX 75001
Phone (800) 420-1036

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1659571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659571200000",
    "number": "1104553767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5057 KELLER SPRINGS RD STE 150",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750016217",
            "telephone_number": "800-420-1036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5057 KELLER SPRINGS RD STE 150",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750016217",
            "telephone_number": "800-420-1036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "WYNTON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-04",
        "last_updated": "2022-08-04",
        "certification_date": "2022-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Addison, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.