Brent Michael Wyatt, MD

Primary specialty

Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X

License

M7769 Issued in TX

Practice address

910 S Kimball Ave
Southlake, TX 76092-9005

Phone

(817) 527-3470

Fax

(817) 527-3444

NPI assigned

Jun 13, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 3

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• 22250 Bulverde Cec Fossil Creek LLC

  • Emergency Care Clinic/Center
  • San Antonio, TX
  • NPI 1740603422
  NPD (past)
• Complete Emergency Care I LLC

  • Emergency Care Clinic/Center
  • San Antonio, TX
  • NPI 1326397274
  NPD (past)

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583366400000",
    "number": "1346283025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2619 SE MILITARY DR STE 101",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782234312",
            "telephone_number": "210-704-1777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 S KIMBALL AVE",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760929005",
            "telephone_number": "817-527-3470",
            "fax_number": "817-527-3444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYATT",
        "first_name": "BRENT",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2020-03-05",
        "certification_date": "2020-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "TX",
            "license": "M7769",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "189948601",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8AH272",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "189948603",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gregory Bob Wright, D.D.S.
• Jerrod Wright, D.C.
• Labrenda Kay Starr Wright
• Paul Sydney Wright, MD
• Wyatt Webb MD PA
• Latoya D. Yaites, PH.D., LPC
• Niki Yari
• Feeyong Yee, PHARM.D
• Sara Yeo, RN
• Yeu Jin Baik, D.D.S., P.C.

• Emergency Medical Services (Emergency Medicine) Physician in Southlake, TX
• Providers in Southlake, TX by specialty
• Emergency Medical Services (Emergency Medicine) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.