ELISABETH KRISTINE WYNNE (M.D.) – Pediatric Surgery Physician, NPI 1801159926
Pediatric Surgery Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
238 GENERAL SURGERY in UT
Provider Addresses for ELISABETH KRISTINE WYNNE (M.D.)
100 N MARIO CAPECCHI DR STE 3800
SALT LAKE CITY, UT 841131103
Phone: (801) 662-2950
Type: Mailing
3333 W Tech Rd
Miamisburg, OH 453420955
Phone: (937) 641-4000
Fax: (937) 641-6492
Type: Location
3535 Southern Blvd
Kettering, OH 454291221
Phone: (937) 641-3000
Type: Location
PO BOX 933432
CLEVELAND, OH 441930039
Phone: (937) 641-3000
Type: Mailing
1 CHILDRENS PLZ
DAYTON, OH 454041873
Phone: (937) 641-3000
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $144.
Total Amount is formed as General ($144) + Research ($0) + Ownership ($0) = $144.
Last reported payment date: 2024-08-20 • Largest payer in this snapshot: Boston Scientific Corporation ($144).
Total Amount
$144
General + Research + Ownership
Payments
1
Total payment records
General Amount
$144
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-08-20
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Boston Scientific Corporation | $144 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2021-09-13
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20190603001243 | I | Pediatric Medicine | UT | TBD |
| I20210913002944 | I | General Surgery | OH | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 84113)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Critical Care (Intensivists) | OH | |
| Emergency Medicine, Pediatric Medicine | NY | |
| G A S T R O E N T E R O L O G Y | OH | |
| - | OH | |
| Pediatric Medicine, General Surgery | OH | |
| A N E S T H E S I O L O G Y | TN | |
| Pediatric Medicine | OH | |
| Critical Care (Intensivists), Pediatric Medicine | OH | |
| H E M A T O L O G Y/ O N C O L O G Y | OH | |
| Pediatric Medicine | OH |
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