Chester M Wynn, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

C8165 Issued in AR

Practice address

118 W Stadium
Magnolia, AR 71753

Phone

(870) 234-6191

NPI assigned

Apr 18, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AR

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Chester Wynn MD PA

  • General Practice Physician
  • Magnolia, AR
  • NPI 1255058822
  NPD Authorized official

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

{
    "created_epoch": "1208476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492473600000",
    "number": "1699949826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 W STADIUM",
            "city": "MAGNOLIA",
            "state": "AR",
            "postal_code": "71753",
            "telephone_number": "870-234-6191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 W STADIUM",
            "city": "MAGNOLIA",
            "state": "AR",
            "postal_code": "71753",
            "telephone_number": "870-234-6191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNN",
        "first_name": "CHESTER",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-18",
        "last_updated": "2017-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "AR",
            "license": "C8165",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "120617001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "55003",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Madison Reed Woodard, RN
• Andrew Woolfley, APRN
• WPM Community Pharmacies LLC
• Erin Wright
• Marcus Bradley Wyatt, ATC
• Michael Jude Yambot, M.D.
• Audrey Noelle Young
• Kailey Young
• Jose U Zamora II, MD
• Andres Zevallos, MHPP

• General Practice Physician in Magnolia, AR
• Providers in Magnolia, AR by specialty
• General Practice Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.