Active NPI
Susan K Wynne, MD
- Psychiatry Physician
- San Antonio, TX
National Provider Identifier
1245305234
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- K1141
- Practice address
- 16007 Via Shavano
Suite 101
San Antonio, TX 78249 - Phone
- (210) 615-8900
- Fax
- (210) 615-9400
- NPI assigned
- Nov 22, 2006
- Last updated
- Feb 9, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | K1141 | TX | Primary |
| Child & Adolescent Psychiatry Physician | 2084P0804X | K1141 | TX |
Addresses
Primary practice location
16007 Via Shavano
Suite 101
San Antonio, TX 78249
Mailing address
16007 Via Shavano
Ste. 101
San Antonio, TX 78249
Phone (210) 615-8900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2017 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| K1141 | TX | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| San Antonio Family Psychiatry | Child & Adolescent Psychiatry | Past | Accepting new patients |
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.
-
- Child & Adolescent Psychiatry Physician
- San Antonio, TX
- NPI 1992367155
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1265673600000",
"number": "1245305234",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16007 VIA SHAVANO",
"address_2": "STE. 101",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "78249",
"telephone_number": "210-615-8900",
"fax_number": "210-615-9400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16007 VIA SHAVANO",
"address_2": "SUITE 101",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "78249",
"telephone_number": "210-615-8900",
"fax_number": "210-615-9400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYNNE",
"first_name": "SUSAN",
"middle_name": "K",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-22",
"last_updated": "2010-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "TX",
"license": "K1141",
"primary": true
},
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "TX",
"license": "K1141",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2010; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.