Vander M Wynn, MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

ME66148 Issued in FL

Practice address

5309 Waterview Dr
North Port, FL 34291-8032

Phone

(239) 261-1158

Fax

(239) 261-4232

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in FL, NC, SC, VA, WV5 enrollments

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 5

Specialty

Anesthesiology

Education

University of Oklahoma College of Medicine, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Medstream Anesthesia PLLCGroup PAC ID 7416198049, 571 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Rutherford Regional Medical Center Hospital, Rutherfordton, NC, CCN 340013

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network

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.

• Medstream Anesthesia PLLC

  • Anesthesiology Physician
  • Richardson, TX
  • NPI 1649616160

  NC, SC, VA, WV

  Medicare reassignment Care Compare group
• Gulf-to-Bay Anesthesiology Associates LLC

  • Anesthesiology Physician
  • Tampa, FL
  • NPI 1720039746
  Medicare reassignment NPD
• Sheridan Healthcorp Inc

  • Anesthesiology Physician
  • Okeechobee, FL
  • NPI 1629781711
  Medicare reassignment NPD
• Davis Memorial Hospital

  • General Acute Care Hospital
  • Elkins, WV
  • NPI 1619964806
  Medicare reassignment NPD
• Gulf-to-Bay Anesthesiology Associates LLC

  • Anesthesiology Physician
  • Largo, FL
  • NPI 1316205339
  NPD
• Sheridan Healthcorp Inc

  • Anesthesiology Physician
  • Wellington, FL
  • NPI 1194843276
  NPD
• Sheridan Healthcorp, Inc.

  • Anesthesiology Physician
  • North Miami Beach, FL
  • NPI 1578429460
  NPD
• Davis Memorial Hospital

  • Community/Retail Pharmacy
  • Elkins, WV
  • NPI 1700663226
  NPD
• Emergency Physician Specialists Inc

  • Emergency Medicine Physician
  • Davenport, FL
  • NPI 1912973850
  NPD (past)
• Harborside Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Punta Gorda, FL
  • NPI 1730118555
  NPD (past)
• Peace River Anesthesiology Associates PA

  • Specialist
  • Punta Gorda, FL
  • NPI 1497737654
  NPD (past)
• Sebastian River Anesthesiology Associates, P. a.

  • Specialist
  • Sebastian, FL
  • NPI 1730161993

  Anesthesiology

  NPD (past)

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

• DLP Rutherford Regional Health System, LLC

  • General Acute Care Hospital
  • Rutherfordton, NC
  • NPI 1245321181
  Care Compare affiliation

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1497866040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5309 WATERVIEW DR",
            "city": "NORTH PORT",
            "state": "FL",
            "postal_code": "342918032",
            "telephone_number": "239-261-1158",
            "fax_number": "239-261-4232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5309 WATERVIEW DR",
            "city": "NORTH PORT",
            "state": "FL",
            "postal_code": "342918032",
            "telephone_number": "239-261-1158",
            "fax_number": "239-261-4232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNN",
        "first_name": "VANDER",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "FL",
            "license": "ME66148",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "281372",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "GA",
            "license": "075180",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "050029800",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "375454500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF FL",
            "identifier": "25438",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Najia Woodie
• Holly B Woodward, R.N.
• Madison Wright
• Mary-Ann Wright
• Jessica Wyckoff, DNP, APRN, FNP-BC
• Natali Yazgi
• Yellow Lotus Clinical Services for Healing & Wellness PLLC
• Tiffany Yelton
• Dawn Zack
• Vanessa Zacroisky, PA-C

• Anesthesiology Physician in North Port, FL
• Providers in North Port, FL by specialty
• Anesthesiology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.