Jill Marie Wortham, PA-C
Individual provider Active NPI Physician Assistant · Tyler, TX
NPI 1346279031 · NPPES record last updated Dec 22, 2015
Key facts
- NPI
- 1346279031
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA01852 (TX)
- Practice address
- 6210 S. Broadway
Tyler, TX 75703 - Phone
- (800) 893-9698
- NPI assigned
- Jul 3, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Texas Spine and Joint Hospital LLC
Practice addresses (Care Compare)
1814 Roseland Blvd
Tyler, TX 75701-4234
Phone (903) 525-3333
2211 S Loop
Suite 256
Palestine, TX 75801-4701
Phone (903) 729-0970
8101 S Broadway Ave
Tyler, TX 75703-5469
Phone (903) 939-0920
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20061017000276 | TX | Practitioner - Physician Assistant | 4688670557 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA01852 | TX | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Texas Emergency Room Services PA | Emergency Medicine | Past | Accepting new patients |
| Camino Real Emergency Physicians PLLC | Emergency Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | PA01852 | TX | |
| Physician Assistant | 363A00000X | PA01852 | TX | Yes |
Addresses
Primary practice location
6210 S. Broadway
Tyler, TX 75703
Mailing address
5904 Churchill Dr
Suite 201
Tyler, TX 75703-4556
Phone (800) 893-9698
Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 22, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.