DERRICK WANSOM (NPI# 1306124912) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306124912 |
| Entity Type | Individual |
| Full Name | DERRICK WANSOM |
| Credential | MD |
| Practice Address |
4100 Duval Rd Bldg 3 Ste 200 Austin TX 78759-4275 |
| Mailing Address |
Po Box 733946 Dallas TX 75373-3946 |
| Practice Telephone | 5124857200 |
| Practice Fax Number | 5124857224 |
| Mailing Telephone | 5124857200 |
| Mailing Fax Number | 5124857224 |
| Enumeration Date | 2011-07-31 |
| Last Update Date | 2019-05-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
Q9077 | TX | Allopathic & Osteopathic Physicians |
| Street Address |
4100 DUVAL RD BLDG 3 STE 200 |
| City | AUSTIN |
| State | TX |
| Zip Code | 78759-4275 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811960693 | Michelle A Berger | Ophthalmology | 4100 Duval Rd, Bldg 4 Ste 205, Austin, TX 78759 | 2006-02-10 |
| 1730730979 | Monarch Medical Management Group, LLC | Contractor | 4100 Duval Rd, Bldg 3, Suite 100, Austin, TX 78759-3550 | 2019-09-27 |
| 1336799667 | Christopher Michael Petiprin | Contractor | 4100 Duval Rd, Building 3, Suite 100, Austin, TX 78759-3550 | 2019-09-18 |
| 1417422676 | Jessica Lynn Laskoskie | Nurse Practitioner | 4100 Duval Rd, Bldg. IIi Suite 200, Austin, TX 78759 | 2018-10-03 |
| 1366959892 | Aabc In Your Home LLC | Midwife | 4100 Duval Rd, Bldg 2 #101, Austin, TX 78759 | 2018-01-05 |
| 1265943765 | Rebekah Lynne Randall | Registered Nurse | 4100 Duval Rd, Austin, TX 78759-3456 | 2017-10-24 |
| 1316478951 | Anne Leclercq | Midwife | 4100 Duval Rd, Austin, TX 78759-3550 | 2017-03-24 |
| 1437696184 | Kimberly Muck | Nurse Practitioner | 4100 Duval Rd, Bldg IIi Ste 200, Austin, TX 78759 | 2017-01-19 |
| 1073985446 | Nicole Antoinette Busch | Clinical Nurse Specialist | 4100 Duval Rd, Bldg IIi Suite 200, Austin, TX 78759 | 2015-10-26 |
| 1942606587 | Pain Specialists of Austin Pharmacy | Pharmacy | 4100 Duval Rd, Building 3 Suite 201, Austin, TX 78759-3550 | 2014-11-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629677612 | Laurel Sunde | Nurse Practitioner | 11111 Research Blvd-ll2, Austin, TX 78759 | 2020-10-20 |
| 1558990242 | Sarah Ann Weier | Counselor | 8500 North Mopac Expressway, Austin, TX 78759 | 2020-04-03 |
| 1124672696 | Gabrielle Jade Hurley | Physical Therapist | 9333 Research Blvd Ste 400, Austin, TX 78759 | 2019-08-01 |
| 1730740671 | Jennifer Kraft | Behavior Technician | 9600 Great Hills Trail, Suite 150w, Austin, TX 78759 | 2019-06-21 |
| 1881199024 | Pediatric Home Healthcare, LLC | Home Health | 8501 N Mopac Expy Ste 410, Austin, TX 78759 | 2018-03-29 |
| 1679072870 | Sylvia Chen | Psychologist | 8400 N Mopac Expy Ste 302, Austin, TX 78759 | 2018-02-03 |
| 1215443064 | Greater Austin Urology, Pllc | Urology | 11673 Jollyville Rd Ste B101, Austin, TX 78759 | 2017-12-15 |
| 1831603042 | Jane A Dykes | Counselor | 9015 Mountain Ridge Dr., Houston Bldg., Ste. 200, Austin, TX 78759 | 2017-11-27 |
| 1134632706 | Gary Victor Friedman | Pharmacist | 4411 Spicewood Springs Road #1111, Austin, TN 78759 | 2017-11-06 |
| 1740720242 | Taylor Renee Cahill | Behavioral Analyst | 9901 North Capital of Texas Hwy, Austin, TX 78759 | 2017-03-02 |
| Find all providers in zip 78759 | ||||
| Taxonomy Code | 208VP0014X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pain Medicine |
| Specialization | Interventional Pain Medicine |
| Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013472265 | Premiere Pain Specialists LLC | Pain Medicine | 12309 N Mopac Expy Ste 125, Austin, TX 78758-2577 | 2019-02-01 |
| 1871970871 | Gregory Nicholas Yanez | Pain Medicine | 4316 James Casey St Building B Suite 200, Austin, TX 78745 | 2015-04-29 |
| 1578567459 | Integrative Pain Services Pa | Pain Medicine | 4807 Spicewood Springs Rd, Ste 1235, Austin, TX 78759-8478 | 2005-06-09 |
| 1487196614 | Alan D Silberberg, Md Pa | Pain Medicine | 5625 Eiger Rd, Suite 160, Austin, TX 78735-8977 | 2016-11-04 |
| 1235514704 | Central Texas Pain Center North, Pllc | Pain Medicine | 4316 James Casey St, Bldg B, Suite 200, Austin, TX 78745-1116 | 2015-07-27 |
| 1821484031 | Jamal Hasoon | Pain Medicine | 4316 James Casey St Ste 200, Austin, TX 78745-1116 | 2015-04-14 |
| 1295130912 | Central Texas Pain Center, Pllc | Pain Medicine | 4316 James Casey St, Bldg B, Suite 200, Austin, TX 78745-1116 | 2014-10-23 |
| 1184987174 | Rahul Sarna | Pain Medicine | 4100 Duval Rd, Bldg IIi Ste 200, Austin, TX 78759 | 2012-06-25 |
| 1336416510 | Robert P Wills Md Pllc | Pain Medicine | 2200 Park Bend Dr, Bldg 1, Suite 201, Austin, TX 78758-5387 | 2011-11-16 |
| 1053526343 | Pain Management Consultants, Pa | Pain Medicine | 101 W Koenig Ln, Ste 100, Austin, TX 78751-1213 | 2007-05-11 |
| Find all providers in AUSTIN | ||||
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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.