NPIMap

Individual provider Active NPI

Joseph O Wyatt, MD

  • Urology Physician
  • Pierre, SD
National Provider Identifier
1871561126
Registry record updated Apr 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
7274 Issued in SD
Practice address
100 Mac Lane
Avera Medical Group Pierre
Pierre, SD 57501
Phone
(605) 945-5259
Fax
(605) 945-5094
NPI assigned
Mar 12, 2006
Last updated
Apr 4, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 025520 AL
Urology Physician 208800000X 7274 SD Primary

Addresses

Primary practice location

100 Mac Lane
Avera Medical Group Pierre
Pierre, SD 57501

Mailing address

100 Mac Lane
Avera Medical Group Pierre
Pierre, SD 57501
Phone (605) 945-5259

Other identifiers 1

IdentifierTypeStateIssuer
7500522MedicaidSD

Other names 1

  • Dr. Wyatt Joe Wollmann Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080716000652 SD Practitioner - Urology 2860565363 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Indiana University School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Avera St MarysGroup PAC ID 0143134965, 97 clinicians

Practice addresses (Care Compare)

801 E Sioux Ave
Pierre, SD 57501-3323
Phone (605) 224-5901

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection22
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
025520ALMDUrology Physician
7274SDMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Avera St Marys CurrentSince Oct 1, 2010 Accepting new patients
Avera St Marys CurrentSince Oct 1, 2010 Accepting new patients
Rural Health Care, Inc. Current Accepting new patients
Rural Health Care, Inc CurrentSince Apr 1, 2024 Accepting new patients
Rural Health Care, Inc CurrentSince Apr 1, 2024 Accepting new patients
Pediatric Hematology Clinic LTD Past Accepting new patients
Pediatric Hematology Oncology Pharmacy LTC Past Accepting new patients

Locations

202 Island Dr
Ste 1
Fort Pierre, SD 57532
Phone (605) 222-0661

100 Mac Ln
Pierre, SD 57501
Phone (605) 224-5901

Interoperability endpoints

  • Direct secure messaging: joseph.wyatt@avera.sdhealthlink.net

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 28

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

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1142121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333497600000",
    "number": "1871561126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MAC LANE",
            "address_2": "AVERA MEDICAL GROUP PIERRE",
            "city": "PIERRE",
            "state": "SD",
            "postal_code": "57501",
            "telephone_number": "605-945-5259",
            "fax_number": "605-945-5094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MAC LANE",
            "address_2": "AVERA MEDICAL GROUP PIERRE",
            "city": "PIERRE",
            "state": "SD",
            "postal_code": "57501",
            "telephone_number": "605-945-5259",
            "fax_number": "605-945-5094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYATT",
        "first_name": "JOSEPH",
        "middle_name": "O",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-12",
        "last_updated": "2012-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "AL",
            "license": "025520",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "SD",
            "license": "7274",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7500522",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "WYATT",
            "last_name": "WOLLMANN",
            "middle_name": "JOE",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Pierre, SD

Sources for this page

Verify at the official NPI Registry.