NPIMap

Individual provider Active NPI

Craig S Wynne, MD

  • Internal Medicine Physician
  • Philadelphia, PA
National Provider Identifier
1538188073
Registry record updated Sep 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD048550L Issued in PA
Practice address
3701 Market St
Suite 560W
Philadelphia, PA 19104-5502
Phone
(215) 662-2250
Fax
(215) 615-3995
NPI assigned
Jul 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X MD048550L PA
Internal Medicine Physician 207R00000X MD048550L PA Primary

Addresses

Primary practice location

3701 Market St
Suite 560W
Philadelphia, PA 19104-5502

Mailing address

3701 Market St
Suite 640
Philadelphia, PA 19104-5502

Other identifiers 1

IdentifierTypeStateIssuer
001462547MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20100708000452 PA Practitioner - Internal Medicine 2365573318 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Albert Einstein College of Medicine of Yeshiva University, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

3701 Market St
Philadelphia, PA 19104-5502
Phone (215) 662-2250

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn - Medical Group Internal Medicine CurrentSince Jan 1, 1966 Accepting new patients
Trustees of the University of Pennsylvania Internal Medicine CurrentSince Apr 1, 2024 Accepting new patients
University of Penn-Medical Group CurrentSince Jan 1, 1966 Accepting new patients
University of Penn - Medical Group Past Accepting new patients

Locations

3701 Market St
Fl 1
Philadelphia, PA 19104
Phone (215) 662-2250

1800 Lombard St
Ste 503
Philadelphia, PA 19146
Phone (215) 893-4150

3701 Market St
Fl 6
Philadelphia, PA 19104
Phone (215) 662-2250

3701 Market St
Ste 640
Philadelphia, PA 19104
Phone (215) 662-2250

3701 Market St
Fl 7
Philadelphia, PA 19104
Phone (215) 349-5200

3400 Spruce St
Fl 6
Philadelphia, PA 19104
Phone (215) 615-0800

3624 Market St
Fl 2
Philadelphia, PA 19104
Phone (215) 615-3669

Organizations & group practices 4

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 7

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": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569542400000",
    "number": "1538188073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3701 MARKET ST",
            "address_2": "SUITE 640",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191045502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3701 MARKET ST",
            "address_2": "SUITE 560W",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191045502",
            "telephone_number": "215-662-2250",
            "fax_number": "215-615-3995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNNE",
        "first_name": "CRAIG",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2019-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "PA",
            "license": "MD048550L",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD048550L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001462547",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.