SHAWN W WYNN (NPI# 1205990843) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205990843 |
| Entity Type | Individual |
| Full Name | SHAWN W WYNN |
| Credential | MD |
| Practice Address |
520 Valley View Dr Moline IL 61265-6194 |
| Practice Telephone | 3097623621 |
| Practice Fax Number | 3097623690 |
| Mailing Telephone | 3097623621 |
| Mailing Fax Number | 3097623690 |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2011-03-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207X00000X | Orthopaedic Surgery | 37086 | IA | Allopathic & Osteopathic Physicians |
| Y | 207X00000X | Orthopaedic Surgery | 036116081 | IL | Allopathic & Osteopathic Physicians |
| N | 207XX0005X |
Orthopaedic Surgery Specialization: Sports Medicine |
37086 | IA | Allopathic & Osteopathic Physicians |
| N | 207XX0005X |
Orthopaedic Surgery Specialization: Sports Medicine |
036116081 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IA | WELLMARK | 55218 | 01 |
| IA | 1205990843 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750749826 | Shawn Michael Wynn | Nurse Anesthetist, Certified Registered | 210 W Walnut St, Canton, IL 61520 | 2016-02-04 |
| Street Address |
520 VALLEY VIEW DR |
| City | MOLINE |
| State | IL |
| Zip Code | 61265-6194 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750369419 | Edward A Connolly | Orthopaedic Surgery | 520 Valley View Dr, Moline, IL 61265-6194 | 2006-01-04 |
| 1306476445 | Lauren Emily Haas | Physician Assistant | 520 Valley View Dr, Moline, IL 61265-6152 | 2020-01-16 |
| 1548621774 | Dana Jo Taylor | Specialist/Technologist | 520 Valley View Dr, Ste. 500, Moline, IL 61265-6152 | 2016-03-16 |
| 1669862264 | Alison Vandegrift | Physical Therapist | 520 Valley View Dr, Moline, IL 61265-6152 | 2015-02-03 |
| 1649670332 | Katherine O'day | Occupational Therapist | 520 Valley View Dr, Moline, IL 61265-6152 | 2014-08-29 |
| 1245648963 | Jamie Porter | Physician Assistant | 520 Valley View Dr, Moline, IL 61265-6194 | 2014-07-25 |
| 1235550567 | Andrew Abatiell Md Pllc | Anesthesiology | 520 Valley View Dr, Moline, IL 61265-6152 | 2014-01-06 |
| 1679823223 | Allison M Mcgraw | Occupational Therapist | 520 Valley View Dr, Ste. 200, Moline, IL 61265-6152 | 2012-09-11 |
| 1073882858 | Ashley M Schurr | Physical Therapist | 520 Valley View Dr, Suite 200, Moline, IL 61265-6152 | 2011-12-22 |
| 1487922738 | Andrea M Black | Physician Assistant | 520 Valley View Dr, Moline, IL 61265-6194 | 2011-12-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861035438 | Ora Orthopedics, PC | Orthopaedic Surgery | 510 Valley View Drive, Moline, IL 61265 | 2019-10-25 |
| 1598231698 | Secure Dental Vi | Dentist | 106 16th St, Unit #90, Moline, IL 61265 | 2018-10-17 |
| 1487152088 | Fjellheim P.c | Chiropractor | 1535 47th Avenue, Suite 5, Moline, IL 61265 | 2018-01-29 |
| 1326567199 | Elizabeth Ann Teichler | Respiratory Therapist, Registered | 4360 7th Street, Moline, IL 61265 | 2017-09-13 |
| 1497279913 | Caroline M Mather | Behavioral Analyst | 2430 6th Avenue, Moline, IL 61265 | 2017-07-26 |
| 1639625239 | Elizabeth Anderson | Nurse's Aide | 4319 26th Ave Apt 1, Moline, IL 61265 | 2016-09-01 |
| 1437604154 | Lindsey Bollaert | Nurse Practitioner | 1100 36th Ave, Moline, IL 61265 | 2016-08-23 |
| 1437541869 | Divvymed, LLC | Pharmacy | 4300 44th Ave, Moline, IL 61265 | 2015-02-23 |
| 1477955250 | Todd Stone | Nurse Practitioner | 1100 3th Avenue, Moline, IL 61265 | 2014-09-23 |
| 1588084479 | Familia Dental Moline LLC | Dentist | 1102 4th Ave, Moline, IL 61265 | 2014-04-18 |
| Find all providers in zip 61265 | ||||
| Taxonomy Code | 207X00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750369419 | Edward A Connolly | Orthopaedic Surgery | 520 Valley View Dr, Moline, IL 61265-6194 | 2006-01-04 |
| 1841501434 | Justin James Munns | Orthopaedic Surgery | 520 Valley View Dr, Moline, IL 61265-6152 | 2010-06-29 |
| 1427374875 | Orthopaedic Specialists PC | Orthopaedic Surgery | 600 Valley View Dr, Lower Level, Moline, IL 61265-6118 | 2010-04-09 |
| 1548426844 | Waqas M Hussain | Orthopaedic Surgery | 520 Valley View Dr, Moline, IL 61265-6152 | 2008-08-06 |
| 1114121969 | Michael Richard Berry | Orthopaedic Surgery | 520 Valley View Dr, Moline, IL 61265-6194 | 2007-06-14 |
| 1811075856 | Jason Craig Clark | Orthopaedic Surgery | 520 Valley View Dr, Moline, IL 61265-6194 | 2006-11-01 |
| 1174501829 | Steven A Boardman | Orthopaedic Surgery | 520 Valley View Dr, Moline, IL 61265-6152 | 2006-01-04 |
| 1265410856 | Mark G Stewart | Orthopaedic Surgery | 520 Valley View Dr, Moline, IL 61265-6152 | 2006-01-04 |
| 1407834906 | Michael A Turner | Orthopaedic Surgery | 520 Valley View Dr, Moline, IL 61265-6194 | 2006-01-04 |
| 1710965223 | Thomas L Vongillern | Orthopaedic Surgery | 520 Valley View Dr, Moline, IL 61265-6152 | 2006-01-04 |
| Find all providers in MOLINE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.