NPIMap

Individual provider Active NPI

Walter L Wynne, M.D.

  • Hospitalist Physician
  • Los Angeles, CA
National Provider Identifier
1396797817
Registry record updated May 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
A043607 Issued in CA
Practice address
2131 W 3Rd St
St Vincent Medical Center
Los Angeles, CA 90057-1901
Phone
(310) 874-0623
NPI assigned
May 16, 2006
Last updated
May 13, 2010By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 13, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X A043607 CA Primary

Addresses

Primary practice location

2131 W 3Rd St
St Vincent Medical Center
Los Angeles, CA 90057-1901

Mailing address

201 Wilshire Blvd
Ste A26
Santa Monica, CA 90401-1212
Phone (310) 874-0623

Other identifiers 1

IdentifierTypeStateIssuer
A043607OtherCASTATE LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040929000848 CA Practitioner - Internal MedicinePractitioner - Family Practice 2668441379 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Cincinnati College of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orchard HospitalGroup PAC ID 6800709049, shared by 4 NPIs, 16 clinicians

Practice addresses (Care Compare)

240 Spruce St
Gridley, CA 95948-2216
Phone (530) 846-9000

284 Spruce St
Gridley, CA 95948-2216
Phone (530) 846-9080

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A043607CAMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Siskiyou Hospital, Inc. CurrentSince Sep 1, 2020 Accepting new patients
Orchard Hospital CurrentSince Sep 7, 2025 Accepting new patients
Glenn Medical Center, LLC Current Accepting new patients
Orchard Hospital Current Accepting new patients
Hospitalist Medicine Physicians of California, Inc Hospitalist Past Accepting new patients
Hollywood Hospitalist Medical Group, Inc. Past Accepting new patients
S Pannu Inc Past Accepting new patients
Hospitalist Medicine Physicians of Monterey County Inc. Past Accepting new patients
Ardent Healthcare, Inc. Hospitalist PastSince Apr 1, 2006 Accepting new patients

Locations

240 Spruce St
Gridley, CA 95948
Phone (530) 846-5671

284 Spruce St
Gridley, CA 95948
Phone (530) 846-4299

1133 W Sycamore St
Willows, CA 95988
Phone (530) 934-1800

444 Bruce St
Yreka, CA 96097
Phone (530) 841-6256

475 Bruce St
Yreka, CA 96097
Phone (530) 842-3507

475 Bruce St
Ste 900
Yreka, CA 96097

Interoperability endpoints

  • Direct secure messaging: walter.wynne.1@32209.direct.athenahealth.com
  • Direct secure messaging: wwynne@yourcarecommunity.org

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1273708800000",
    "number": "1396797817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 WILSHIRE BLVD",
            "address_2": "STE A26",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904011212",
            "telephone_number": "310-874-0623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2131 W 3RD ST",
            "address_2": "ST VINCENT MEDICAL CENTER",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900571901",
            "telephone_number": "310-874-0623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNNE",
        "first_name": "WALTER",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2010-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "CA",
            "license": "A043607",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "A043607",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.