NPIMap

Individual provider Active NPI

Tanya Renee Wynn, M.D.

  • Obstetrics & Gynecology Physician
  • Lake Orion, MI
National Provider Identifier
1356574909
Registry record updated Oct 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
4301086589 Issued in MI
Practice address
1428 S Lapeer Rd
Lake Orion, MI 48360-1437
Phone
(248) 693-0543
NPI assigned
Aug 31, 2009
Sex
Female
Sole proprietor
No

Organizations & group practices 16

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.

Hospital & facility affiliations 1

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

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Saint Louis University School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
W. a. Foote Memorial Hospital, Inc. 476 clinicians

Practice addresses (Care Compare)

205 N E Ave
Jackson, MI 49201-1753

Hospital & facility affiliations

  • Henry Ford Allegiance Health Hospital, Jackson, MI, CCN 230092

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Medicare enrollment records 2

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
I20091117000521 MI Practitioner - Obstetrics/Gynecology 4486792132 Reassigns benefits to 2 organizations
I20191025000199 TX Practitioner - Obstetrics/Gynecology 4486792132

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
W.a. Foote Memorial Hospital, Inc Obstetrics & Gynecology CurrentSince Feb 19, 2022 Accepting new patients
Obhg Michigan, PC Obstetrics & Gynecology CurrentSince Apr 1, 2023 Accepting new patients
W.a. Foote Memorial Hospital, Inc CurrentSince Feb 19, 2022 Accepting new patients
Wa Foote Memorial Hospital, Inc Current Accepting new patients
Women'S Healthcare Associates of Oakland PLLC PastSince Nov 1, 2010 Accepting new patients
Henry Ford Macomb Hospital Corporation Past Accepting new patients
W.a. Foote Memorial Hospital Past Accepting new patients

Locations

205 N East Ave
Jackson, MI 49201
Phone (517) 788-4730

Interoperability endpoints

  • Direct secure messaging: twynn758468@direct.hfhs.org

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 4301086589 MI Primary

Addresses

NPPES NPI Registry

Primary practice location

1428 S Lapeer Rd
Lake Orion, MI 48360-1437

Mailing address

PO Box 2137
Birmingham, MI 48012-2137
Phone (248) 693-0543

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 2, 2012.

{
    "created_epoch": "1251676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349136000000",
    "number": "1356574909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2137",
            "city": "BIRMINGHAM",
            "state": "MI",
            "postal_code": "480122137",
            "telephone_number": "248-693-0543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1428 S LAPEER RD",
            "city": "LAKE ORION",
            "state": "MI",
            "postal_code": "483601437",
            "telephone_number": "248-693-0543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNN",
        "first_name": "TANYA",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-31",
        "last_updated": "2012-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": "4301086589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Orion, MI

Sources for this page

Verify at the official NPI Registry.