NPIMap

Organization Active NPI

Wynn Medical Center

  • Health Service Clinic/Center
  • Duffield, VA
National Provider Identifier
1457056566
Registry record updated May 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
WYNN MEDICAL CENTER
Practice address
225 Boone Trail Rd
Suite 200
Duffield, VA 24244
Phone
(276) 231-9228
NPI assigned
Mar 31, 2023
Last updated
May 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 30, 2024

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

Authorized official

Name
Lisa Ann Wynn, FNPNPI 1295065688
Title
Provider
Phone
(276) 231-9228

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X Primary

Addresses

Primary practice location

225 Boone Trail Rd
Suite 200
Duffield, VA 24244

Mailing address

PO Box 408
Duffield, VA 24244-0408
Phone (276) 231-9227

Other practice location 1

145 Dollar Dr
Pennington Gap, VA 24277-7230
Phone (276) 231-9228 ext. 1001

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230412001526 VA Part B Supplier - Clinic/Group Practice 8224403860 Receives reassigned benefits from 1 practitioner
Practice locations: Duffield, VA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D2280429Wynn Medical Center PLLC145 Dollar Dr, Pennington Gap, VA 24277Certificate of waiverApr 18, 2027

National Provider Directory

National Provider Directory

Locations

145 Dollar Dr
Pennington Gap, VA 24277
Phone 2762319228 ext. 1001

41718 W Morgan Ave
Pennington Gap, VA 24277

41718 W Morgan Ave
#101
Pennington Gap, VA 24277
Phone (276) 231-9228

Practitioners & affiliated clinicians

Practitioners 37

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1680220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717027200000",
    "number": "1457056566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 408",
            "city": "DUFFIELD",
            "state": "VA",
            "postal_code": "242440408",
            "telephone_number": "276-231-9227",
            "fax_number": "949-695-2477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 BOONE TRAIL RD",
            "address_2": "SUITE 200",
            "city": "DUFFIELD",
            "state": "VA",
            "postal_code": "24244",
            "telephone_number": "276-231-9228"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "145 Dollar Dr",
            "address_purpose": "LOCATION",
            "city": "Pennington Gap",
            "state": "VA",
            "postal_code": "242777230",
            "country_code": "US",
            "telephone_number": "276-231-9228 x1001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WYNN MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-31",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-30",
        "status": "A",
        "authorized_official_last_name": "WYNN",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "276-231-9228",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duffield, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.