Derrick Wansom, MD

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

Q9077 Issued in TX

Practice address

1320 Wonder World Dr Ste 106
San Marcos, TX 78666-7558

Phone

(512) 851-1165

Fax

(833) 925-2433

NPI assigned

Jul 31, 2011

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 TX

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

Pain ManagementAlso: Anesthesiology

Education

Wayne State University School of Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Lone Star Spine and Pain Institute PLLCGroup PAC ID 4486032349, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Christus Santa Rosa Hospital-San Marcos Hospital, San Marcos, TX, CCN 450272

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dwansom289369@christushealth.direct-ci.net
• FHIR API: https://api.platform.athenahealth.com/26539/brand/1/csg/1/fhir/r4
• Direct secure messaging: derrick.wansom.1@26539.direct.athenahealth.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.

• Lone Star Spine and Pain Institute PLLC

  • Interventional Pain Medicine Physician
  • San Marcos, TX
  • NPI 1851036347
  Medicare reassignment Care Compare group NPD
• Gastromedconnect, PLLC

  • Gastroenterology Physician
  • Kyle, TX
  • NPI 1639852189
  NPD (past)

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

• Christus Santa Rosa Health Care Corporation

  dba Christus Santa Rosa Hospital - New Braunfels

  • General Acute Care Hospital
  • New Braunfels, TX
  • NPI 1114725033
  Care Compare affiliation
• Christus Santa Rosa Health Care Corporation

  dba Christus Santa Rosa Hospital - San Marcos

  • General Acute Care Hospital
  • San Marcos, TX
  • NPI 1447883301
  Care Compare affiliation

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

{
    "created_epoch": "1312070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668988800000",
    "number": "1306124912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 WONDER WORLD DR STE 106",
            "city": "SAN MARCOS",
            "state": "TX",
            "postal_code": "786667558",
            "telephone_number": "512-851-1165",
            "fax_number": "512-485-7224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 WONDER WORLD DR STE 106",
            "city": "SAN MARCOS",
            "state": "TX",
            "postal_code": "786667558",
            "telephone_number": "512-851-1165",
            "fax_number": "833-925-2433"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2115 Stephens Pl Ste 1400",
            "address_purpose": "LOCATION",
            "city": "New Braunfels",
            "state": "TX",
            "postal_code": "781302159",
            "country_code": "US",
            "telephone_number": "830-715-0538",
            "fax_number": "833-925-2433",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WANSOM",
        "first_name": "DERRICK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-31",
        "last_updated": "2022-11-21",
        "certification_date": "2022-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "TX",
            "license": "Q9077",
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "TX",
            "license": "Q9077",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Kiana Wallace, M.S., CCC-SLP
• Jack Wesley Wallis, MD
• Mary M Wally, SLP
• Kathryn Nicole Walpole
• Andrew Lee Walsh III, MD
• Robert L Ward, DO
• Meredith Collings Ware, B.S.
• O A Watson Jr., OD
• Taylin Evette Watson, DPT
• Carolyn I. Watts, L.P.C.

• Pain Medicine (Anesthesiology) Physician in San Marcos, TX
• Providers in San Marcos, TX by specialty
• Pain Medicine (Anesthesiology) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2022; 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.