Active NPI
Samuel Phillip Wyche Jr., D.O.
- Psychiatry Physician
- Wyndmoor, PA
National Provider Identifier
1861596892
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- OS-005924-L
- Practice address
- 8200 Flourtown Ave
Suite 1 B
Wyndmoor, PA 19038-7976 - Phone
- (215) 836-7014
- NPI assigned
- Sep 11, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | OS-005924-L | PA | Primary |
Addresses
Primary practice location
8200 Flourtown Ave
Suite 1 B
Wyndmoor, PA 19038-7976
Mailing address
8200 Flourtown Ave
Suite 1 B
Wyndmoor, PA 19038-7976
Phone (215) 836-7014
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 Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS-005924-L | PA | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Men & Women for Human Excellence, 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 and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Decatur, GA
- NPI 1770930026
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157932800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1861596892",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8200 FLOURTOWN AVE",
"address_2": "SUITE 1 B",
"city": "WYNDMOOR",
"state": "PA",
"postal_code": "190387976",
"telephone_number": "215-836-7014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8200 FLOURTOWN AVE",
"address_2": "SUITE 1 B",
"city": "WYNDMOOR",
"state": "PA",
"postal_code": "190387976",
"telephone_number": "215-836-7014"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYCHE",
"first_name": "SAMUEL",
"middle_name": "PHILLIP",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "PA",
"license": "OS-005924-L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wyndmoor, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.