Active NPI
Willie G. Wyatt, M.D.
- Family Medicine Physician
- Oklahoma City, OK
National Provider Identifier
1538199443
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 9068
- Practice address
- 5720 W Memorial Rd
Oklahoma City, OK 73142-2010 - Phone
- (405) 470-7100
- Fax
- (405) 470-7111
- NPI assigned
- Jul 4, 2006
- Last updated
- Oct 4, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 9068 | OK | Primary |
Addresses
Primary practice location
5720 W Memorial Rd
Oklahoma City, OK 73142-2010
Mailing address
5300 N Independence Ave Ste 280
Oklahoma City, OK 73112-5555
Phone (405) 552-0155
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9068 | Other | OK | LICENSE |
| 100116560B | Medicaid | OK |
Other names 1
- Will G. Wyatt
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9068 | OK | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Health Services Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Mercy After Hours
- Medical Specialty Clinic/Center
- Yukon, OK
- NPI 1255398251
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1538611200000",
"number": "1538199443",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5300 N INDEPENDENCE AVE STE 280",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731125555",
"telephone_number": "405-552-0155",
"fax_number": "405-713-7690"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5720 W MEMORIAL RD",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731422010",
"telephone_number": "405-470-7100",
"fax_number": "405-470-7111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYATT",
"first_name": "WILLIE",
"middle_name": "G.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-04",
"last_updated": "2018-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OK",
"license": "9068",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "9068",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100116560B",
"state": "OK"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "WILL",
"last_name": "WYATT",
"middle_name": "G.",
"credential": "M.D.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.