MARY G MATTISON-WYNN PSY D LP
NPI 1649202755
Psychologist in Buffalo, MN

Active since July 07, 2006PECOS EnrolledAccepts Medicare Assignment
30 1ST AVE NE # 12, BUFFALO, MN 55313(612) 670-8918(952) 300-8194 Get Directions Write a Review

NPPES record last updated: September 30, 2024. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Sep 30, 2024, Mar 17, 2018, Nov 27, 2017 (3 updates tracked since 2017).

About Mary G Mattison-wynn Psy D Lp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARY G MATTISON-WYNN PSY D LP (NPI 1649202755) is an individual psychologist in Buffalo, Minnesota, licensed in Minnesota (LP4961) and active in the NPI registry since July 2006. She is enrolled in Medicare PECOS and is a graduate of Other (2000).

NPPES Registry Identity

NPI1649202755
Entity TypeIndividualFemale
Primary Taxonomy103T00000X
Provider Legal NameMARY G MATTISON-WYNNCredential: PSY D LP
Location Address30 1ST AVE NE # 12Buffalo, MN 55313-1515
Mailing AddressPo Box 80Hamel, MN 55340-0080 · (612) 670-8918 · Fax (952) 300-8194
Fax(952) 300-8194
Sole ProprietorNo
Medical School CMSOtherGraduated 2000
Enumeration DateJuly 7, 2006
Last NPPES UpdateSeptember 30, 20243 updates tracked since enumeration
NPPES CertifiedSeptember 30, 2024
✔ NPI 1649202755 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License✔ Licensed in MN · LP4961
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
Also ListedPsychologist · ClinicalTaxonomy 103TC0700X · License 4961 (MN)
30 1ST AVE NE # 12, Buffalo, MN 55313

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mary G Mattison-wynn Psy D Lp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2466450143
PECOS Enrollment IDI20081119000074
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

2

Medicare enrollment records show Mary Mattison-wynn reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Mental Health (Including Community Mental Health Center)
30 1ST AVE NE
Buffalo, MN 55313
  • Reassigned Medicare billing, Minnesota enrollment
Urgent Care
755 CROSSROADS CAMPUS DR NE STE 100
Buffalo, MN 55313
  • Reassigned Medicare billing, Minnesota enrollment
  • 3,733 clinicians in this Medicare group

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Psychiatric diagnostic evaluation 90791
A psychiatric diagnostic evaluation is a thorough assessment used to identify any mental health conditions you may have. It involves a detailed discussion about your symptoms, thoughts, feelings and behavior patterns. Your medical history and family's mental health history are also considered.
11 services11 patients

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mary Mattison-wynn's NPI number?

The NPI number for Mary Mattison-wynn is 1649202755. It was assigned to this individual provider in the NPPES registry on July 7, 2006.

Where is Mary Mattison-wynn located?

Mary Mattison-wynn practices at 30 1st Ave NE # 12, Buffalo, MN 55313. The listed phone number is (612) 670-8918.

What is Mary Mattison-wynn's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Mary Mattison-wynn enrolled in Medicare?

Yes. Mary Mattison-wynn is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Mary Mattison-wynn's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Mary Mattison-wynn reassigns Medicare benefits to 2 organizations: Woodhaven Wellness LLC (Buffalo, MN) and Allina Health System (Buffalo, MN). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Mary Mattison-wynn's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Mary Mattison-wynn accept?

Health plans from HealthPartners list Mary Mattison-wynn as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Mary Mattison-wynn was last updated on September 30, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.