Wylan Cornelius Peterson, M.D.

Primary specialty

Surgical Critical Care PhysicianTaxonomy code 2086S0102X

License

Q0151 Issued in TX

Practice address

3551 Roger Brooke Dr
Att'N Ms. Shawana Judge
Fort Sam Houston, TX 78234-4504

Phone

(210) 916-1064

NPI assigned

Jul 26, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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 1

Specialty

General SurgeryAlso: Critical Care (Intensivists), Pulmonary Disease

Education

University of Missouri, Kansas City, School of Medicine, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Texas Acute Care Surgery LLCGroup PAC ID 8729462981, 10 clinicians

Usacs Critical Care Medicine Services of Texas PLLCGroup PAC ID 1153681796, 74 clinicians

Gulf Coast Intensivists, PLLCGroup PAC ID 2264896364, 39 clinicians

Central Texas Intensivists PLLCGroup PAC ID 8921446345, 20 clinicians

Seton Family of DoctorsGroup PAC ID 0941333280, 785 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St David'S South Austin Medical Center Hospital, Austin, TX, CCN 450713
• Christus Santa Rosa Hospital-San Marcos Hospital, San Marcos, TX, CCN 450272
• Christus Spohn Hospital Corpus Christi Hospital, Corpus Christi, TX, CCN 450046
• Ascension Seton Hays Hospital, Kyle, TX, CCN 670056

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: wylan.peterson.1@27482.direct.athenahealth.com

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.

• Central Texas Intensivists, PLLC

  • Critical Care Medicine (Internal Medicine) Physician
  • San Marcos, TX
  • NPI 1205690765
  Medicare reassignment Care Compare group NPD
• Gulf Coast Intensivists, PLLC

  • Critical Care Medicine (Internal Medicine) Physician
  • Corpus Christi, TX
  • NPI 1104509199
  Medicare reassignment Care Compare group NPD
• Texas Acute Care Surgery LLC

  • Surgery Physician
  • Austin, TX
  • NPI 1699430298
  Medicare reassignment Care Compare group NPD
• Usacs Critical Care Medicine Services of Texas, PLLC

  • Critical Care Medicine (Internal Medicine) Physician
  • Cedar Park, TX
  • NPI 1023522554
  Medicare reassignment Care Compare group NPD
• Seton Family of Doctors

  • Neurological Surgery Physician
  • Austin, TX
  • NPI 1588997233
  Medicare reassignment Care Compare group
• Capital Area Surgeons PLLC

  • Surgery Physician
  • Austin, TX
  • NPI 1285831412
  Medicare reassignment NPD
• Cepamerica Texas PA

  • Critical Care Medicine (Internal Medicine) Physician
  • San Antonio, TX
  • NPI 1881269934
  Medicare reassignment NPD
• Southeast Texas Intensivists, PLLC

  • Critical Care Medicine (Internal Medicine) Physician
  • Beaumont, TX
  • NPI 1801579867
  Medicare reassignment NPD
• Texas Ips LLC

  • Pulmonary Disease Physician
  • San Antonio, TX
  • NPI 1629368535

  Critical Care Medicine

  Medicare reassignment NPD
• Cepamerica Texas PA

  • Critical Care Medicine (Internal Medicine) Physician
  • San Antonio, TX
  • NPI 1932774080
  NPD
• St. David'S Healthcare Partnership, L.P., LLP

  • General Acute Care Hospital
  • Austin, TX
  • NPI 1679528889
  NPD (past)

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

• Ascension Seton

  • General Acute Care Hospital
  • Kyle, TX
  • NPI 1619115383
  Care Compare affiliation
• Christus Santa Rosa Health Care Corporation

  • General Acute Care Hospital
  • New Braunfels, TX
  • NPI 1114725033
  Care Compare affiliation
• Christus Santa Rosa Health Care Corporation

  • General Acute Care Hospital
  • San Marcos, TX
  • NPI 1447883301
  Care Compare affiliation
• Christus Spohn Health System Corporation

  • General Acute Care Hospital
  • Corpus Christi, TX
  • NPI 1689641680
  Care Compare affiliation
• St. David'S Healthcare Partnership, L.P., LLP

  • General Acute Care Hospital
  • Austin, TX
  • NPI 1679528889
  Care Compare affiliation

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718668800000",
    "number": "1659395523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3551 ROGER BROOKE DR",
            "address_2": "ATT'N MS. SHAWANA JUDGE",
            "city": "FORT SAM HOUSTON",
            "state": "TX",
            "postal_code": "782344504",
            "telephone_number": "210-916-1064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3551 ROGER BROOKE DR",
            "address_2": "ATT'N MS. SHAWANA JUDGE",
            "city": "FORT SAM HOUSTON",
            "state": "TX",
            "postal_code": "782344504",
            "telephone_number": "210-916-1064"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 Elizabeth St",
            "address_purpose": "LOCATION",
            "city": "Corpus Christi",
            "state": "TX",
            "postal_code": "784042235",
            "country_code": "US",
            "telephone_number": "361-881-3000",
            "fax_number": "361-881-3149",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4310 James Casey St Ste 3C",
            "address_purpose": "LOCATION",
            "city": "Austin",
            "state": "TX",
            "postal_code": "787451120",
            "country_code": "US",
            "telephone_number": "512-326-2800",
            "fax_number": "512-441-6388",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "WYLAN",
        "middle_name": "CORNELIUS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2024-06-18",
        "certification_date": "2024-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "TX",
            "license": "Q0151",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "OH",
            "license": "35-08-5446",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "Q0151",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "TX",
            "license": "Q0151",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Petersen, DPT
• Jack Martin Peterson, MD
• Kelly Peterson, APRN
• Telyn J Peterson, DO
• Thomas Joseph Peterson, MD
• Patrick Calvin Petray, EM PA-C
• James A Pfaff, M.D.
• Wilson Bartlett Pfeiffer, DO
• Hoang Nguyen Pham, M.D.
• Thang N Pham, MD

• Surgical Critical Care Physician in Fort Sam Houston, TX
• Providers in Fort Sam Houston, TX by specialty
• Surgical Critical Care Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2024; 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.