NPIMap

Individual provider Active NPI

Wiley Douglas Bunn Jr., MD

  • Gynecologic Oncology Physician
  • Syracuse, NY
National Provider Identifier
1902982473
Registry record updated Jan 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecologic Oncology PhysicianTaxonomy code 207VX0201X
License
200121 Issued in NY
Practice address
475 Irving Avenue
Suite 204
Syracuse, NY 13210
Phone
(315) 634-4112
Fax
(315) 634-4117
NPI assigned
Oct 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecologic Oncology Physician 207VX0201X 200121 NY Primary

Addresses

Primary practice location

475 Irving Avenue
Suite 204
Syracuse, NY 13210

Mailing address

475 Irving Avenue
Suite 204
Syracuse, NY 13210
Phone (315) 634-4112

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20100329000096 NY Practitioner - Obstetrics/GynecologyPractitioner - Medical OncologyPractitioner - Gynecological Oncology 0648205591 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/GynecologyAlso: Medical Oncology
Education
University of Southern California Keck School of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University OB/GYN AssociatesGroup PAC ID 9133117740, 36 clinicians

Practice addresses (Care Compare)

475 Irving Ave
Suite 204
Syracuse, NY 13210-1529
Phone (315) 634-4112

725 Irving Ave
Suite 600
Syracuse, NY 13210-1688
Phone (315) 464-5162

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.06 of 100Reported as group
Quality
96.61
Promoting interoperability
100
Improvement activities
40
Cost
31.11

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus42

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME0062339FLMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University OB/GYN Associates CurrentSince Sep 23, 2019 Accepting new patients
Crouse Health Hospital, Inc. Past Accepting new patients
GYN Oncology Associates Gynecologic Oncology Past Accepting new patients
Samuel S. Badalian MD PC Past Accepting new patients
Township Eye Associates of Coconut Creek., P.a. PastSince Jan 1, 2001 Accepting new patients

Locations

475 Irving Ave
Ste 204
Syracuse, NY 13210
Phone (315) 634-4112

725 Irving Ave
Ste 600
Syracuse, NY 13210
Phone (315) 464-5162

Interoperability endpoints

  • Direct secure messaging: wbunn12047@direct.upstate.edu

Organizations & group practices 5

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579219200000",
    "number": "1902982473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 IRVING AVENUE",
            "address_2": "SUITE 204",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "13210",
            "telephone_number": "315-634-4112",
            "fax_number": "315-634-4117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 IRVING AVENUE",
            "address_2": "SUITE 204",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "13210",
            "telephone_number": "315-634-4112",
            "fax_number": "315-634-4117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUNN",
        "first_name": "WILEY",
        "middle_name": "DOUGLAS",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-27",
        "last_updated": "2020-01-17",
        "certification_date": "2020-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VX0201X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecologic Oncology",
            "state": "NY",
            "license": "200121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.