Individual provider Active NPI

Matthew Wynne, MD

  • Emergency Medicine Physician
  • Jackson, TN
National Provider Identifier
1306263678
Registry record updated Nov 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
53625 Issued in TN
Practice address
620 Skyline Dr
Jackson, TN 38301-3923
Phone
(731) 541-5000
Fax
(731) 410-0367
NPI assigned
Mar 25, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD0000053625 TN
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X 53625 TN Primary

Addresses

Primary practice location

620 Skyline Dr
Jackson, TN 38301-3923

Mailing address

620 Skyline Dr
Jackson, TN 38301-3923
Phone (731) 541-5000

Other practice location 1

294 Summar Dr
Jackson, TN 38301-3915
Phone (731) 423-1932 ext. 323

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20160427001103 TN Practitioner - Emergency MedicinePractitioner - Family Practice 0941429591 Reassigns benefits to 11 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency MedicineAlso: Family Practice
Education
University of Tennessee, HSC, College of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeastern Emergency Physicians LLCGroup PAC ID 2466364997, 776 clinicians
Germantown Emergency Physicians, PLLCGroup PAC ID 7214386812, 29 clinicians

Practice addresses (Care Compare)

2986 Kate Bond Rd
Bartlett, TN 38133-4003
Phone (901) 820-7000

7691 Poplar Ave
Germantown, TN 38138-3904
Phone (901) 516-6000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
53625TNMDEmergency Medicine Physician
MD0000053625TNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Central Physicians PLLC CurrentSince Jul 9, 2020 Accepting new patients
Emergency Coverage, LLC Emergency Medicine CurrentSince Jul 1, 2016 Accepting new patients
Methodist North Emergency Physicians, PLLC Emergency Medicine CurrentSince Nov 1, 2024 Accepting new patients
University of Tennessee Family Medicine CurrentSince Jun 1, 2017 Accepting new patients
Methodist South Emergency Physicians, PLLC Emergency Medicine CurrentSince Nov 1, 2024 Accepting new patients
WT University Medical Associates Inc Family Medicine Current Accepting new patients
Southeastern Emergency Physicians LLC Emergency Medicine CurrentSince Oct 1, 2022 Accepting new patients
Erx Group, LLC Emergency Medicine CurrentSince Sep 4, 2017 Accepting new patients
University of Tennessee CurrentSince Jun 1, 2017 Accepting new patients
Concord Medical Group of Texas PLLC Emergency Medicine CurrentSince Feb 29, 2016 Accepting new patients
Emergency Medical Care Facilities PC Emergency Medicine CurrentSince Jul 15, 2017 Accepting new patients
Concord Medical Group PLLC Emergency Medicine CurrentSince Feb 29, 2016 Accepting new patients
Germantown Emergency Physicians, PLLC Emergency Medicine CurrentSince Nov 1, 2024 Accepting new patients
Methodist University Emergency Physicians PLLC Emergency Medicine CurrentSince Nov 1, 2024 Accepting new patients
Emergency Coverage Services, PC Past Accepting new patients

Locations

2986 Kate Bond Rd
Bartlett, TN 38133
Phone (901) 765-1000

9400 Rhea County Hwy
Dayton, TN 37321
Phone (423) 285-5220

5001 E Main St
Erin, TN 37061
Phone (336) 944-6420

294 Summar Dr
Jackson, TN 38301
Phone (731) 423-1932

620 Skyline Dr
Jackson, TN 38301
Phone (731) 541-4923

9352 Park West Blvd
Knoxville, TN 37923
Phone (865) 373-1000

1607 S Locust Ave
Lawrenceburg, TN 38464
Phone (731) 287-2244

5959 Park Ave
Memphis, TN 38119
Phone (901) 765-1000

3960 New Covington Pike
Memphis, TN 38128
Phone (901) 516-5200

1265 Union Ave
Memphis, TN 38104
Phone (901) 516-2362

1300 Wesley Dr
Memphis, TN 38116
Phone (901) 516-3700

7691 Poplar Ave
Memphis, TN 38138
Phone (901) 516-1290

326 Asbury Ave
Ripley, TN 38063
Phone (731) 221-2200

451 Highway 13 S
Waverly, TN 37185
Phone (931) 296-0211

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 4

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": "1395705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667952000000",
    "number": "1306263678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 SKYLINE DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013923",
            "telephone_number": "731-541-5000",
            "fax_number": "731-410-0367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 SKYLINE DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383013923",
            "telephone_number": "731-541-5000",
            "fax_number": "731-410-0367"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "294 Summar Dr",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "TN",
            "postal_code": "383013915",
            "country_code": "US",
            "telephone_number": "731-423-1932 x323",
            "fax_number": "731-410-0367",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WYNNE",
        "first_name": "MATTHEW",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-25",
        "last_updated": "2022-11-09",
        "certification_date": "2022-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "MD0000053625",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "53625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, TN

Sources for this page

Verify at the official NPI Registry.