Individual provider Active NPI

Phillip A Wynn, M.D.

  • Emergency Medicine Physician
  • Iowa City, IA
National Provider Identifier
1184821332
Registry record updated Jun 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
A111985 Issued in CA
Practice address
200 Hawkins Dr
Iowa City, IA 52242-1009
Phone
(319) 356-1616
Fax
(319) 384-6004
NPI assigned
Jun 29, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X R-8063 IA
Emergency Medicine Physician 207P00000X A111985 CA Primary

Addresses

Primary practice location

200 Hawkins Dr
Iowa City, IA 52242-1009

Mailing address

200 Hawkins Dr
Iowa City, IA 52242-1009
Phone (319) 356-1616

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20100915000052 CA Practitioner - Emergency Medicine 3173650355 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Iowa, RJ & L Carver College of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cep America - CaliforniaGroup PAC ID 6103739131, shared by 2 NPIs, 1,278 clinicians

Practice addresses (Care Compare)

15031 Rinaldi St
Mission Hills, CA 91345-1207
Phone (818) 365-8051

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.69 of 100Reported as group
Quality
90
Improvement activities
40
Cost
78.43

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
111985CAMDMarriage & Family Therapist
A111985CAMDEmergency Medicine Physician
R-8063IAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Victory Emergency Physicians Medical Group Inc Emergency Medicine CurrentSince Jan 1, 2017 Accepting new patients
Cep America - California Emergency Medicine CurrentSince Jun 16, 2022 Accepting new patients
Cep America - California Emergency Medicine Current Accepting new patients
Ridgeline Emergency Physicians Medical Group, Inc. Emergency Medicine CurrentSince Jan 1, 2017 Accepting new patients
Burbank Emergency Medical Group Inc Emergency Medicine CurrentSince Jan 1, 2017 Accepting new patients
Cep America - California Emergency Medicine CurrentSince Apr 1, 2016 Accepting new patients
Cep America - California Emergency Medicine Current Accepting new patients
Cep America-California Emergency Medicine CurrentSince Apr 1, 2016 Accepting new patients

Locations

501 S Buena Vista St
Burbank, CA 91505
Phone (818) 783-0800

2309 Antonio Ave
Camarillo, CA 93010
Phone (805) 389-5655

751 Medical Center Ct
#1182
Chula Vista, CA 91911

2755 Herndon Ave
Clovis, CA 93611
Phone (559) 323-4000

31872 Coast Hwy
Laguna Beach, CA 92651
Phone (949) 499-1311

24451 Health Center Dr
Laguna Hills, CA 92653
Phone (949) 452-3573

1720 E Cesar E Chavez Ave
Los Angeles, CA 90033
Phone (323) 260-5781

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

18300 Roscoe Blvd
Northridge, CA 91325
Phone (818) 885-5331

1600 N Rose Ave
Oxnard, CA 93030
Phone (805) 988-2500

15031 Rinaldi St
San Fernando, CA 91345
Phone (818) 365-8051

1400 E Church St
Santa Maria, CA 93454
Phone (805) 739-3000

4401 W Memorial Rd
Ste 121
Oklahoma City, OK 73134
Phone (405) 749-4560

Organizations & group practices 8

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1183075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654646400000",
    "number": "1184821332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HAWKINS DR",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522421009",
            "telephone_number": "319-356-1616",
            "fax_number": "319-384-6004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HAWKINS DR",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522421009",
            "telephone_number": "319-356-1616",
            "fax_number": "319-384-6004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNN",
        "first_name": "PHILLIP",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-29",
        "last_updated": "2022-06-08",
        "certification_date": "2022-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IA",
            "license": "R-8063",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A111985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Iowa City, IA

Sources for this page

Verify at the official NPI Registry.