Derrick Chate Wansom (NPI# 1306124912, PAC ID# 1153625470) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PAIN MANAGEMENT.
| Nation Provider ID (NPI) | 1306124912 |
| PAC ID by PECOS | 1153625470 |
| Professional Enrollment ID | I20160810000199 |
| Full Name | Derrick Chate Wansom |
| Organization Legal Name | CENTRAL TEXAS PAIN INSTITUTE PLLC |
| Address |
3101 Hwy 71 E Suite 211 Bastrop TX 78602-5157 |
| Phone Number | 5124857200 |
| Gender | M |
| Medical School | WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE |
| Graduation Year | 2011 |
| Primary Specialty | PAIN MANAGEMENT |
| Secondary Specialties | ANESTHESIOLOGY |
| Group Practice PAC ID | 6103802384 |
| Number of Group Practice Members | 14 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 450143 | SETON SMITHVILLE REGIONAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 2500 W William Cannon Dr, Suite 206, Austin, TX 78745-5288 | 5124857200 | CENTRAL TEXAS PAIN INSTITUTE PLLC |
| 3101 Hwy 71 E, Suite 211, Bastrop, TX 78602-5157 | 5124857200 | CENTRAL TEXAS PAIN INSTITUTE PLLC |
| Organization Legal Name | CENTRAL TEXAS PAIN INSTITUTE PLLC |
| Physicians | 17 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Pankaj Mehta | Pain Management | Central Texas Pain Institute Pllc | 3202 S W S Young Dr, Suite 102, Killeen, TX 76542-6538 |
| Gary L Heath | Pain Management | Central Texas Pain Institute Pllc | 10252 W Adams Ave, Temple, TX 76502-5848 |
| John W Wages | Interventional Pain Management | Central Texas Pain Institute Pllc | 3201 S Austin Ave, Suite 265, Georgetown, TX 78626-7641 |
| Nicole Busch | Nurse Practitioner | Central Texas Pain Institute Pllc | 3201 S Austin Ave, Suite 265, Georgetown, TX 78626-7641 |
| Brittney A Misercola | Nurse Practitioner | Central Texas Pain Institute Pllc | 1507 W Main St, Gatesville, TX 76528-1024 |
| Rahul Sarna | Anesthesiology | Central Texas Pain Institute Pllc | 3201 S Austin Ave, Suite 265, Georgetown, TX 78626-7641 |
| Misti L Schroll | Nurse Practitioner | Central Texas Pain Institute Pllc | 10252 W Adams Ave, Temple, TX 76502-5848 |
| Umar Mahmood | Pain Management | Central Texas Pain Institute Pllc | 10252 W Adams Ave, Temple, TX 76502-5848 |
| Jessica Lynn Laskoskie | Nurse Practitioner | Central Texas Pain Institute Pllc | 3202 S W S Young Dr, Suite 102, Killeen, TX 76542-6538 |
| Kimberly Muck | Nurse Practitioner | Central Texas Pain Institute Pllc | 4100 Duval Rd, Bldg IIi, Austin, TX 78759-4275 |
| Street Address |
3101 HWY 71 E SUITE 211 |
| City | BASTROP |
| State | TX |
| Zip | 78602-5157 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Brian L Sullivan | Orthopedic Surgery | Family Health Center of Bastrop Pllc | 3101 Hwy 71 E, Suite 101, Bastrop, TX 78602-5159 |
| Clyde D Smith | General Surgery | Family Health Center of Bastrop Pllc | 3101 Hwy 71 E, Suite 101, Bastrop, TX 78602-5159 |
| Fletcher Douglas Srygley Iv | Gastroenterology | Austin Gastroenterology Pa | 3101 Hwy 71 E, Suite 207, Bastrop, TX 78602-5157 |
| Paul Anthony Tucker Ii | Interventional Cardiology | St Davids Heart and Vascular Pllc | 3101 Hwy 71 E, Suite 201 Tx Heart and Vascular, Bastrop, TX 78602-5157 |
| Gerald V Levy | Cardiovascular Disease (cardiology) | St Davids Heart and Vascular Pllc | 3101 Hwy 71 E, Suite 201 Tx Heart and Vascular, Bastrop, TX 78602-5157 |
| Diana Ann Yens | Rheumatology | Family Health Center of Bastrop Pllc | 3101 Hwy 71 E, Suite 101, Bastrop, TX 78602-5159 |
| Vinh Dinh Nguyen | Cardiovascular Disease (cardiology) | St Davids Heart and Vascular Pllc | 3101 Hwy 71 E, Suite 201 Tx Heart and Vascular, Bastrop, TX 78602-5157 |
| Estela M Mota | Family Medicine | Family Health Center of Bastrop Pllc | 3101 Hwy 71 E, Suite 101, Bastrop, TX 78602-5159 |
| David W Terreson | Interventional Cardiology | St Davids Heart and Vascular Pllc | 3101 Hwy 71 E, Suite 201 Tx Heart and Vascular, Bastrop, TX 78602-5157 |
| James E Handy | Podiatry | Family Health Center of Bastrop Pllc | 3101 Hwy 71 E, Suite 101, Bastrop, TX 78602-5159 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Elizabeth Hill | Psychiatry | Bluebonnet Trails Community Mhmr Center | 10 Settlement Dr, Bastrop County Menta, Bastrop, TX 78602 |
| Elizabeth G Yarotsky | Physician Assistant | Butler and Burns Ear Nose and Throat Associates | 441 Hwy 71 W, Suite H, Bastrop, TX 78602 |
| John Holtzclaw | Qualified Audiologist | Butler and Burns Ear Nose and Throat Associates | 441 Hwy 71 W, Suite H, Bastrop, TX 78602 |
| Abila F Awan | Psychiatry | Bluebonnet Trails Community Mhmr Center | 10 Settlement Dr, Bastrop County Menta, Bastrop, TX 78602 |
| Brenda R Chao | Obstetrics/gynecology | Central Texas Ob/gyn Associates, Pllc | 815 Hwy 71 W 1150, Renaissance Women's Group Bastrop, Bastrop, TX 78602-0319 |
| Mischca T Scales | Clinical Psychologist | Mischca T. Scales, Phd, Pllc | 815 Hwy 71 W, Suite 1150, Bastrop, TX 78602-0319 |
| Rebecca Teng | Obstetrics/gynecology | Central Texas Ob/gyn Associates, Pllc | 815 Hwy 71 W 1150, Renaissance Women's Group Bastrop, Bastrop, TX 78602-0319 |
| Beth L Thai | Obstetrics/gynecology | Central Texas Ob/gyn Associates, Pllc | 815 Hwy 71 W 1150, Renaissance Women's Group Bastrop, Bastrop, TX 78602-0319 |
| Jessica E Macleod | Obstetrics/gynecology | Central Texas Ob/gyn Associates, Pllc | 815 Hwy 71 W 1150, Renaissance Women's Group Bastrop, Bastrop, TX 78602-0319 |
| Desmar Walkes | General Practice | 815 Hwy 71 W 1150, Bastrop, TX 78602-0319 | |
| Find all physicians in zip 78602 | |||
| City | BASTROP |
| Zip Code | 78602 |
| Specialty | PAIN MANAGEMENT |
| City + Specialty | BASTROP + PAIN MANAGEMENT |
Please comment or provide details below to improve the information on Derrick Chate Wansom.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.