Koley Chance Pack

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

T8007 Issued in TX

Practice address

2001 S Coulter St
Amarillo, TX 79106-2521

Phone

(806) 318-5777

Fax

(806) 513-6926

NPI assigned

Apr 18, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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

Family Practice

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Moore County Hospital DistrictGroup PAC ID 1254226269, 44 clinicians

NWTX Physician Network PLLCGroup PAC ID 4688899149, 30 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorial Hospice Hospice, Dumas, TX, CCN 451538
• Memorial Hospital Hospital, Dumas, TX, CCN 451386

Merit-based Incentive Payment System (MIPS)

Final score

99.52 of 100Reported as apm

Quality

87.98

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Moore County Hospital District

  • Critical Access Hospital
  • Dumas, TX
  • NPI 1700991700

  Family Medicine

  Medicare reassignment Care Compare group NPD
• NWTX Physician Network, PLLC

  • Family Medicine Physician
  • Amarillo, TX
  • NPI 1790109916
  Medicare reassignment Care Compare group NPD
• NWTX Physician Network, PLLC

  • Rural Health Clinic/Center
  • Borger, TX
  • NPI 1790665610
  NPD

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

• Moore County Hospital District

  • Critical Access Hospital
  • Dumas, TX
  • NPI 1700991700

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1555545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662595200000",
    "number": "1255994836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 S COULTER ST",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791062521",
            "telephone_number": "806-318-5777",
            "fax_number": "806-513-6926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 S COULTER ST",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791062521",
            "telephone_number": "806-318-5777",
            "fax_number": "806-513-6926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACK",
        "first_name": "KOLEY",
        "middle_name": "CHANCE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-18",
        "last_updated": "2022-09-08",
        "certification_date": "2022-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "T8007",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda B Owens, MPAS, PA-C
• Kate Robyn Owens, R.N.
• Pablo R. Diaz-Esquivel MD PA
• Brooke Ann Pace, DPT
• John David Pack, MS, LPC, LCDC
• Lindsey Packard, PT, DPT
• Luain Packard
• Kristy Paddack, LPC
• Stanley Carl Paetzold, MD
• Robert W Paige, M.D.

• Family Medicine Physician in Amarillo, TX
• Providers in Amarillo, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2022; 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.