NPIMap

Organization Active NPI

Allison Wyman MD LLC

  • Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
  • Tampa, FL
National Provider Identifier
1629780143
Registry record updated Oct 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urogynecology and Reconstructive Pelvic Surgery (Urology) PhysicianTaxonomy code 2088F0040X
Legal business name
ALLISON WYMAN MD LLC
Doing business as
Allison Wyman MD LLC
Practice address
2919 W Swann Ave Ste 404
Tampa, FL 33609-4052
Phone
(813) 773-0579
NPI assigned
Dec 15, 2022
Last updated
Oct 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2024

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

Authorized official

Name
Maria Otero, CREDENTIALING
Title
Credentialing Specialist
Phone
(727) 499-0351

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician 207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician 2088F0040X Primary

Addresses

Primary practice location

2919 W Swann Ave Ste 404
Tampa, FL 33609-4052

Mailing address

2410 Northside Dr
Clearwater, FL 33761-2236
Phone (727) 499-0351

Other practice location 1

5460 63rd St E
Bradenton, FL 34203-7808
Phone (813) 773-0579

Other names 1

  • Allison Wyman MD LLC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230110000712 FL Part B Supplier - Clinic/Group Practice 9638549553 Receives reassigned benefits from 5 practitioners
Practice locations: Bradenton, FL; Tampa, FL

National Provider Directory

National Provider Directory

Locations

5460 63rd St E
Unit B
Bradenton, FL 34203
Phone (941) 202-2305

6600 University Pkwy
Ste 305
Sarasota, FL 34240
Phone (941) 241-0161

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1671062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729468800000",
    "number": "1629780143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2410 NORTHSIDE DR",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337612236",
            "telephone_number": "727-499-0351",
            "fax_number": "727-781-3312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2919 W SWANN AVE STE 404",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336094052",
            "telephone_number": "813-773-0579"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5460 63rd St E",
            "address_purpose": "LOCATION",
            "city": "Bradenton",
            "state": "FL",
            "postal_code": "342037808",
            "country_code": "US",
            "telephone_number": "813-773-0579",
            "fax_number": "941-253-3401",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ALLISON WYMAN MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-15",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A",
        "authorized_official_last_name": "OTERO",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "727-499-0351",
        "authorized_official_credential": "CREDENTIALING"
    },
    "taxonomies": [
        {
            "code": "207VF0040X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2088F0040X",
            "taxonomy_group": "",
            "desc": "Urology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Allison Wyman MD LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Allison Wyman MD LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.