THEODORE CRISOSTOMO-WYNNE (MD) – Urology Physician, NPI 1316486186
Urology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
318 UROLOGY in WA
Provider Addresses for THEODORE CRISOSTOMO-WYNNE (MD)
9040 FITZSIMMONS DR
JOINT BASE LEWIS MCCHORD, WA 984311000
Phone: (253) 968-2417
Type: Mailing
MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
TACOMA, WA 984310001
Phone: (253) 968-1110
Type: Location
PO BOX 50095
SEATTLE, WA 981455095
Phone:
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 7 Open Payments records for all available years, with a total value of $269.
Total Amount is formed as General ($269) + Research ($0) + Ownership ($0) = $269.
Last reported payment date: 2024-10-18 • Largest payer in this snapshot: COLOPLAST CORP ($195).
Total Amount
$269
General + Research + Ownership
Payments
7
Total payment records
General Amount
$269
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-18
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| COLOPLAST CORP | $195 |
| Boston Scientific Corporation | $73 |
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: 2025-05-23
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 |
|---|---|---|---|---|
| I20220825003455 | I | Urology | WA | TBD |
| I20250523000549 | I | Urology | OR | 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 98431)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | WA | |
| Nurse Practitioner | WA | |
| - | IL | |
| O P H T H A L M O L O G Y | OR | |
| O P H T H A L M O L O G Y | WA | |
| Nurse Practitioner | WA | |
| Family Practice | WA | |
| Interventional Radiology, Diagnostic Radiology | OH | |
| Physician Assistant | ID | |
| Clinical Psychologist | WA |
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