NPIMap

Individual provider Active NPI

Mike Preston Berry Jr., M.D.

  • Emergency Medicine Physician
  • Amarillo, TX
National Provider Identifier
1033485453
Registry record updated Apr 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
Q5349 Issued in TX
Practice address
1600 Wallace Blvd
Amarillo, TX 79106-1799
Phone
(806) 212-2000
Fax
(806) 212-2735
NPI assigned
Mar 29, 2012
Last updated
Apr 18, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X 87223 MT
Emergency Medicine Physician 207P00000X MD2015-0299 NM
Emergency Medicine Physician 207P00000X Q5349 TX Primary

Addresses

Primary practice location

1600 Wallace Blvd
Amarillo, TX 79106-1799

Mailing address

1600 Wallace Blvd
Amarillo, TX 79106-1799
Phone (806) 212-2000

Other practice location 1

310 Sunnyview Ln
Kalispell, MT 59901-3129
Phone (406) 752-1733

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address krmcmedicalrecords@krhdirect.org Kalispell Regional Medical Center Inc

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, MT2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20151215001365 TX Practitioner - Emergency Medicine 9335374636 Reassigns benefits to 3 organizations
I20240215000987 MT Practitioner - Emergency Medicine 9335374636 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Texas Tech University Health Science Center School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

310 Sunnyview LN
Kalispell, MT 59901-3129
Phone (406) 751-6488

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
87223MTMDEmergency Medicine Physician
MD2015-0299NMMDEmergency Medicine Physician
Q5349TXMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kalispell Regional Medical Center, Inc CurrentSince Apr 1, 2024 Accepting new patients
Nes Southwest Medical Services Inc Emergency Medicine CurrentSince Apr 1, 2023 Accepting new patients
Kalispell Regional Medical Center Inc Current Accepting new patients
Kalispell Regional Medical Center Inc CurrentSince Apr 1, 2024 Accepting new patients
Acs Primary Care Physicians Southwest, PA Emergency Medicine CurrentSince Oct 15, 2024 Accepting new patients
Glacier Regional Pathology, LTD. Current Accepting new patients
Em Alliance Texas, PLLC Emergency Medicine CurrentSince Nov 12, 2024 Accepting new patients
St. John's Lutheran Hospital, Inc. CurrentSince Mar 1, 2025 Accepting new patients
St. John's Lutheran Hospital, Inc. Past Accepting new patients

Locations

310 Sunnyview Ln
Kalispell, MT 59901
Phone (406) 751-5310

350 Heritage Way
Ste 2100
Kalispell, MT 59901
Phone (406) 257-8992

75 Claremont St
Ste H
Kalispell, MT 59901
Phone (406) 752-7406

209 Health Park Dr
Libby, MT 59923
Phone (406) 283-7000

1501 S Coulter St
Amarillo, TX 79106
Phone (800) 354-1150

1600 Wallace Blvd
Amarillo, TX 79106
Phone (806) 212-2000

1600 Wallace Blvd
#H
Amarillo, TX 79106
Phone (806) 212-2000

4121 S Georgia St
Amarillo, TX 79110
Phone (561) 203-0611

4207 W Amarillo Blvd
Amarillo, TX 79106
Phone (806) 351-7850

8960 Hillside Rd
Amarillo, TX 79119
Phone (806) 351-6987

2901 4th St
Longview, TX 75605
Phone (281) 371-1800

500 N Highland Ave
Sherman, TX 75092
Phone (903) 870-4494

Interoperability endpoints

  • Direct secure messaging: jberry84358@ahs.direct-ci.com
  • Direct secure messaging: krmcmedicalrecords@krhdirect.org

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1332979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744934400000",
    "number": "1033485453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 WALLACE BLVD",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791061799",
            "telephone_number": "806-212-2000",
            "fax_number": "806-212-2735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 WALLACE BLVD",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791061799",
            "telephone_number": "806-212-2000",
            "fax_number": "806-212-2735"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "310 Sunnyview Ln",
            "address_purpose": "LOCATION",
            "city": "Kalispell",
            "state": "MT",
            "postal_code": "599013129",
            "country_code": "US",
            "telephone_number": "406-752-1733",
            "fax_number": "406-752-7854",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERRY",
        "first_name": "MIKE",
        "middle_name": "PRESTON",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-03-29",
        "last_updated": "2025-04-18",
        "certification_date": "2025-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MT",
            "license": "87223",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NM",
            "license": "MD2015-0299",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "Q5349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krmcmedicalrecords@krhdirect.org",
            "affiliation": "Y",
            "affiliationName": "Kalispell Regional Medical Center Inc",
            "address_1": "310 Sunnyview Ln",
            "city": "Kalispell",
            "state": "MT",
            "country_code": "US",
            "postal_code": "599013129",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Amarillo, TX

Sources for this page

Verify at the official NPI Registry.