Active NPI
Timothy F Wynkoop, PHD
- Clinical Neuropsychologist
- Maumee, OH
National Provider Identifier
1336299064
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 5089
- Practice address
- 1627 Henthorne
Maumee, OH 43537 - Phone
- (419) 867-8019
- NPI assigned
- Jan 12, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 5089 | OH | Primary |
Addresses
Primary practice location
1627 Henthorne
Maumee, OH 43537
Mailing address
PO Box 332
Maumee, OH 43537
Phone (419) 867-8019
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120203000255 | OH | Practitioner - Clinical Psychologist | 7911164868 | Practice locations: Toledo, OH; Fremont, OH; Maumee, OH; Sylvania, OH |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
6049 Renaissance PL
Suite B
Toledo, OH 43623-4711
Phone (419) 867-8019
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5089 | OH | MD | Clinical Neuropsychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323043200000",
"number": "1336299064",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 332",
"city": "MAUMEE",
"state": "OH",
"postal_code": "43537",
"telephone_number": "419-867-8019"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1627 HENTHORNE",
"city": "MAUMEE",
"state": "OH",
"postal_code": "43537",
"telephone_number": "419-867-8019"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYNKOOP",
"first_name": "TIMOTHY",
"middle_name": "F",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-12",
"last_updated": "2011-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "OH",
"license": "5089",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maumee, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2011; 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.