Jeremy Blake Wells, M.D.

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

22493 Issued in MS

Practice address

103 Medical Park FL 2
Hattiesburg, MS 39401-9042

Phone

(601) 268-5630

Fax

(601) 579-3285

NPI assigned

Jul 1, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Sports MedicineAlso: Family Practice

Education

University of Mississippi School of Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hattiesburg Clinic PAGroup PAC ID 5193706794, 525 clinicians

Wayne General HospitalGroup PAC ID 2668457581, 47 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wayne General Hospital Hospital, Waynesboro, MS, CCN 250077
• Forrest General Hospital Hospital, Hattiesburg, MS, CCN 250078
• South Central Reg Med Ctr Hospital, Laurel, MS, CCN 250058
• Marion General Hospital Hospital, Columbia, MS, CCN 250085

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jwells46316@directpatientrecord.com

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

• Hattiesburg Clinic PA

  • Multi-Specialty Clinic/Center
  • Hattiesburg, MS
  • NPI 1740213446

  MS

  Medicare reassignment Care Compare group NPD
• Wayne General Hospital

  • Clinic/Center
  • Waynesboro, MS
  • NPI 1407233612

  MS

  Medicare reassignment Care Compare group NPD
• Hattiesburg Clinic, PA

  • Primary Care Clinic/Center
  • Flowood, MS
  • NPI 1912600354
  NPD
• Wayne General Hospital

  • Hospitalist Physician
  • Waynesboro, MS
  • NPI 1699589143
  NPD
• State of Mississippi - University of Mississippi Medical Center

  • Critical Access Hospital
  • Lexington, MS
  • NPI 1386630705
  NPD (past)
• Wayne General Hospital

  • Rural Health Clinic/Center
  • Waynesboro, MS
  • NPI 1285882662

  Family Medicine

  NPD (past)
• Wayne General Hospital

  • Rural Health Clinic/Center
  • Waynesboro, MS
  • NPI 1558963496

  Family Medicine

  NPD (past)
• Wayne General Hospsital

  • Interventional Cardiology Physician
  • Waynesboro, MS
  • NPI 1902021546
  NPD (past)

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

• Forrest County General Hospital

  • General Acute Care Hospital
  • Hattiesburg, MS
  • NPI 1225041809

  Hospital

  Care Compare affiliation
• Forrest County General Hospital

  • General Acute Care Hospital
  • Columbia, MS
  • NPI 1427320993

  Hospital

  Care Compare affiliation
• South Central Regional Medical Center

  • General Acute Care Hospital
  • Laurel, MS
  • NPI 1619973542

  Hospital

  Care Compare affiliation
• Wayne General Hospital

  • General Acute Care Hospital
  • Waynesboro, MS
  • NPI 1679559983

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1309478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715212800000",
    "number": "1144517822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017246",
            "telephone_number": "601-268-5630",
            "fax_number": "601-579-5240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 MEDICAL PARK FL 2",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394019042",
            "telephone_number": "601-268-5630",
            "fax_number": "601-579-3285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELLS",
        "first_name": "JEREMY",
        "middle_name": "BLAKE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-01",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "MS",
            "license": "22493",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "T-2501",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06927265",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jwells46316@directpatientrecord.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "103 Medical Park Fl 2",
            "city": "Hattiesburg",
            "state": "MS",
            "country_code": "US",
            "postal_code": "394019042",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Thomas Louis Welch, MD
• Gail Davis Weldy, R.N.
• Cameron Wells
• Cathryne E Wells, SLP
• Emily Wells
• John Wells, CRNA
• Joseph Kyle Wells, CRNA
• Maria Wells, FNP
• Rokeshia Wells, LMFT
• Wesley Health System LLC

• Sports Medicine (Family Medicine) Physician in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• Sports Medicine (Family Medicine) Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.