Brad L Wynn, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

O-0676 Issued in ID

Practice address

1308 8TH St Ste 1
Rupert, ID 83350-1535

Phone

(208) 436-4322

Fax

(208) 436-1312

NPI assigned

Jun 19, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

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

Family Practice

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Minidoka Memorial HospitalGroup PAC ID 7315908894, shared by 4 NPIs, 38 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Minidoka Memorial Hospital Hospital, Rupert, ID, CCN 131319
• Cassia Regional Hospital Hospital, Burley, ID, CCN 131326

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bwynn@minidokamh.securechart.com
• Direct secure messaging: bwynn626362@direct.ochin.org

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.

• Minidoka Memorial Hospital

  • Emergency Care Clinic/Center
  • Rupert, ID
  • NPI 1134333495

  Family Medicine

  Medicare reassignment NPD
• Minidoka Memorial Hospital

  • Critical Access Hospital
  • Rupert, ID
  • NPI 1679553531
  Medicare reassignment NPD
• Minidoka Memorial Hospital

  • Rural Health Clinic/Center
  • Rupert, ID
  • NPI 1043387426
  NPD (past)
• St Luke'S Clinic LLC

  • Family Medicine Physician
  • Twin Falls, ID
  • NPI 1790718229
  NPD (past)
• St Luke'S Magic Valley Regional Medical Center LTD

  • Community/Retail Pharmacy
  • Twin Falls, ID
  • NPI 1760203921
  NPD (past)

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

• Ihc Health Services, Inc.

  • General Acute Care Hospital
  • Burley, ID
  • NPI 1497865315
  Care Compare affiliation
• Minidoka Memorial Hospital

  • Critical Access Hospital
  • Rupert, ID
  • NPI 1679553531
  Care Compare affiliation

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

{
    "created_epoch": "1245369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692921600000",
    "number": "1902033608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1224 8TH STREET",
            "city": "RUPERT",
            "state": "ID",
            "postal_code": "833501527",
            "telephone_number": "208-434-4236",
            "fax_number": "208-436-6038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1308 8TH ST STE 1",
            "city": "RUPERT",
            "state": "ID",
            "postal_code": "833501535",
            "telephone_number": "208-436-4322",
            "fax_number": "208-436-1312"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1224 8th Street",
            "address_purpose": "LOCATION",
            "city": "RUPERT",
            "state": "ID",
            "postal_code": "833501527",
            "country_code": "US",
            "telephone_number": "208-434-4236",
            "fax_number": "208-436-6038",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WYNN",
        "first_name": "BRAD",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-19",
        "last_updated": "2023-08-25",
        "certification_date": "2023-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "O-0676",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1902033608",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hayden Wheatley, PA-C
• Ryan James Wilkinson, LMSW
• Bill Rhys Williams, O.D.
• Gerald A Woodworth, D.M.D.
• Darin L Wright, MD
• Kevin Nathan Yearsley, PHARM.D

• Family Medicine Physician in Rupert, ID
• Providers in Rupert, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2023; 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.