Marisa Marie Wynne, D.O.

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

License

34.009421 Issued in OH

Practice address

1934 Niles Cortland Rd NE Ste B
Warren, OH 44484-1055

Phone

(330) 841-4032

Fax

(330) 841-4381

NPI assigned

Nov 28, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Marisa Marie Gates Former name

Medicare fee-for-service enrollment

Enrolled in OH

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

Ohio University, College of Osteopathic Medicine, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mercy Health Physicians Youngstown Specialty Care LLCGroup PAC ID 3476950296, 463 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• HMHP St Elizabeth Boardman Health Center Hospital, Boardman, OH, CCN 360276
• MH St Elizabeth Youngstown Hospital Hospital, Youngstown, OH, CCN 360064

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Mercy Health Physicians Youngstown Specialty Care LLC

  • Surgery Physician
  • Youngstown, OH
  • NPI 1649892225
  Medicare reassignment Care Compare group NPD
• Mercy Health Physicians Youngstown, LLC

  • Family Medicine Physician
  • Youngstown, OH
  • NPI 1154636066
  Medicare reassignment NPD
• North East Ohio Group Practice LLC

  • Internal Medicine Physician
  • Middleburg Heights, OH
  • NPI 1063575462
  Medicare reassignment NPD
• Mercy Health Physicians Youngstown LLC

  • Durable Medical Equipment & Medical Supplies
  • Boardman, OH
  • NPI 1750920245
  NPD
• Mercy Health Physicians Youngstown Specialty Care LLC

  • Durable Medical Equipment & Medical Supplies
  • Boardman, OH
  • NPI 1386316107
  NPD
• Mercy Health Physicians Youngstown Specialty Care LLC

  • Dentist
  • Youngstown, OH
  • NPI 1609544055
  NPD
• Western Reserve Professional Group Inc

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Kent, OH
  • NPI 1699986620

  Interventional Pain Medicine

  NPD (past)

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

• Mercy Health Youngstown LLC

  • General Acute Care Hospital
  • Youngstown, OH
  • NPI 1548296106
  Care Compare affiliation
• Mercy Health Youngstown LLC

  • General Acute Care Hospital
  • Youngstown, OH
  • NPI 1790868982
  Care Compare affiliation
• Mercy Health Youngstown LLC

  • Clinical Medical Laboratory
  • Youngstown, OH
  • NPI 1831600295

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1196208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525305600000",
    "number": "1346422615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1934 NILES CORTLAND RD NE STE B",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "444841055",
            "telephone_number": "330-841-4032",
            "fax_number": "330-841-4381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1934 NILES CORTLAND RD NE STE B",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "444841055",
            "telephone_number": "330-841-4032",
            "fax_number": "330-841-4381"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "905 Sahara Trl",
            "address_purpose": "LOCATION",
            "city": "Poland",
            "state": "OH",
            "postal_code": "445143687",
            "country_code": "US",
            "telephone_number": "330-729-8972",
            "fax_number": "330-729-8973",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WYNNE",
        "first_name": "MARISA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-28",
        "last_updated": "2018-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OH",
            "license": "34.009421",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "OH",
            "license": "34.009421",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "OH",
            "license": "34.009421",
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "OH",
            "license": "34.009421",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0082233",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARISA",
            "last_name": "GATES",
            "middle_name": "MARIE",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Anna Wright, LPN
• Blondina Wright, LPN
• Cody A Wright
• Cory Lee Wright
• WSB Rehabilitation Services, Inc
• Rochelle L Wysinger, P.C.C.
• Donna Yake, M.A.
• Courtney Tenneille Yancy, LPN
• James Yasnowski, OD
• Patricia Yauger

• Pain Medicine Physician in Warren, OH
• Providers in Warren, OH by specialty
• Pain Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2018; 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.