Active NPI
Pamela J Wymore, M.D.
- Diagnostic Radiology Physician
- St. Paul, MN
National Provider Identifier
1760429138
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 37571
- Practice address
- 166 4TH Street E
St. Paul, MN 55101 - Phone
- (651) 292-2000
- Fax
- (651) 292-2136
- NPI assigned
- Jun 2, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 37571 | MN | Primary |
Addresses
Primary practice location
166 4TH Street E
St. Paul, MN 55101
Mailing address
166 4TH Street E
St. Paul, MN 55101
Phone (651) 292-2000
Other practice location 1
7505 Metro Blvd Ste 400
Edina, MN 55439-3010
Phone (612) 573-2200
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00201776 | Other | MN | RAILROAD MEDICARE MN |
| 1030863 | Other | MN | PREFERRED ONE |
| 1603279 | Other | MN | MEDICA |
| 089807400 | Medicaid | MN | |
| 502T0WY | Other | MN | BLUE CROSS |
| 2182694 | Other | MN | AMERICA'S PPO |
| 502T1WY | Other | MN | BLUE CROSS |
| 34234600 | Medicaid | WI | |
| HP43094 | Other | MN | HEALTHPARTNERS |
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 |
|---|---|---|---|
| 47480 | MN | MD | Cardiovascular Disease Physician |
| 37571 | MN | MD | Diagnostic Radiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1760429138",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "166 4TH STREET E",
"city": "ST. PAUL",
"state": "MN",
"postal_code": "55101",
"telephone_number": "651-292-2000",
"fax_number": "651-292-2136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "166 4TH STREET E",
"city": "ST. PAUL",
"state": "MN",
"postal_code": "55101",
"telephone_number": "651-292-2000",
"fax_number": "651-292-2136"
}
],
"practiceLocations": [
{
"address_1": "7505 Metro Blvd Ste 400",
"address_purpose": "LOCATION",
"city": "Edina",
"state": "MN",
"postal_code": "554393010",
"country_code": "US",
"telephone_number": "612-573-2200",
"fax_number": "612-573-2274",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WYMORE",
"first_name": "PAMELA",
"middle_name": "J",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-02",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "MN",
"license": "37571",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE MN",
"identifier": "P00201776",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "1030863",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "1603279",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "089807400",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "502T0WY",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICA'S PPO",
"identifier": "2182694",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "502T1WY",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "34234600",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS",
"identifier": "HP43094",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in St. Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.