| Derrick Wansom, MD | |
|
1320 Wonder World Dr Ste 106, San Marcos, TX 78666-7558 | |
| (512) 851-1165 | |
| (833) 925-2433 |
| Full Name | Derrick Wansom |
|---|---|
| Gender | Male |
| Speciality | Pain Management |
| Experience | 15 Years |
| Location | 1320 Wonder World Dr Ste 106, San Marcos, Texas |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306124912 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207LP2900X | Anesthesiology - Pain Medicine | Q9077 (Texas) | Primary |
| 208VP0014X | Pain Medicine - Interventional Pain Medicine | Q9077 (Texas) | Secondary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Guadalupe Regional Medical Center | Seguin, TX | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Lone Star Spine And Pain Institute Pllc | 4486032349 | 3 |
| Entity Name | Lone Star Spine And Pain Institute Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1851036347 PECOS PAC ID: 4486032349 Enrollment ID: O20220606000218 |
| Mailing Address | Practice Location Address |
|---|---|
| Derrick Wansom, MD 1320 Wonder World Dr Ste 106, San Marcos, TX 78666-7558 Ph: (512) 851-1165 | Derrick Wansom, MD 1320 Wonder World Dr Ste 106, San Marcos, TX 78666-7558 Ph: (512) 851-1165 |
Dr. John Christopher Smith, MD Anesthesiology Medicare: Accepting Medicare Assignments Practice Location: 1301 Wonder World Dr, San Marcos, TX 78666 Phone: 512-753-3627 Fax: 254-200-4090 | |
Dr. Charles Thomas Porter Jr., MD Anesthesiology Medicare: Not Enrolled in Medicare Practice Location: 1301 Wonder World Dr, San Marcos, TX 78666 Phone: 512-753-3627 Fax: 254-200-4090 |