David Wyncott, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01070512A Issued in IN

Practice address

611 E Douglas Rd
Suite 407
Mishawaka, IN 46545-1464

Phone

(574) 335-6500

NPI assigned

Jun 11, 2010

Last updated

Sep 14, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IN

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

Specialty

Family Practice

Education

George Washington University School of Medicine, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Saint Joseph Regional Medical Center-South Bend Campus IncGroup PAC ID 3476451790, 65 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Joseph Regional Medical Center Hospital, Mishawaka, IN, CCN 150012

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dwyncott1154616@direct.trinity-health.org
• FHIR API: https://fhir-myrecord.cerner.com/r4/5ac0007d-0893-4627-b11f-857c06d27ab1/
• FHIR API: https://fhir-myrecord.cerner.com/r4/781d290a-0fb7-4574-b825-dd38fe495caa/

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.

• Saint Joseph Regional Medical Center-South Bend Campus, Inc

  dba Saint Joseph Regional Medical Center-South Bend Campus Inc Mobile Med

  • Mobile Mammography Clinic/Center
  • South Bend, IN
  • NPI 1023844693
  Medicare reassignment Care Compare group NPD
• Saint Joseph Regional Medical Center, Inc.

  dba Saint Joseph Medical Group

  • Pulmonary Disease Physician
  • Plymouth, IN
  • NPI 1225082878
  Medicare reassignment NPD
• Saint Joseph Regional Medical Center-South Bend Campus, Inc.

  dba Family Medicine Faculty Physicians

  • Family Medicine Physician
  • Mishawaka, IN
  • NPI 1144580150
  NPD
• Saint Joseph Regional Medical Center-South Bend Campus, Inc.

  • General Acute Care Hospital
  • Mishawaka, IN
  • NPI 1841245594
  NPD
• Saint Joseph Regional Medical Center-South Bend Campus, Inc.

  dba Family Medicine Center of SJRMC

  • Family Medicine Physician
  • Mishawaka, IN
  • NPI 1780766261
  NPD (past)

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

• Saint Joseph Regional Medical Center-South Bend Campus, Inc.

  • General Acute Care Hospital
  • Mishawaka, IN
  • NPI 1023965795
  Care Compare affiliation
• Saint Joseph Regional Medical Center-South Bend Campus, Inc.

  • General Acute Care Hospital
  • Mishawaka, IN
  • NPI 1841245594
  Care Compare affiliation

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

{
    "created_epoch": "1276214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473811200000",
    "number": "1194046250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 E CEDAR ST",
            "address_2": "STE 200",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172057",
            "telephone_number": "574-335-6550",
            "fax_number": "574-335-0791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 E DOUGLAS RD",
            "address_2": "SUITE 407",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465451464",
            "telephone_number": "574-335-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNCOTT",
        "first_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-11",
        "last_updated": "2016-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01070512A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2011107870",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCARE RR GROUP",
            "identifier": "CN4033",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura Wright
• Michael Wroblewski, OT
• Annie Wu, DO
• Henry Wu, MD
• Yufeng Kevin Wu, MD
• Michael Wysong, PHARMD
• Cheryl Yancey, RN
• Celia W Yang, PHARM.D.
• Yi Yang, LMT
• Carrie Yarger, PT

• Family Medicine Physician in Mishawaka, IN
• Providers in Mishawaka, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2016; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.