Tracey G Wellendorf, MD

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

30594 Issued in IA

Practice address

405 S Clark St
Suite 215
Carroll, IA 51401-3065

Phone

(712) 792-4368

Fax

(712) 792-2056

NPI assigned

Oct 14, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IA

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

Otolaryngology

Education

University of Iowa, RJ & L Carver College of Medicine, 1990

Medicare assignment

May accept Medicare assignment

Group practices

St Anthony Regional Hospital and Nursing HomeGroup PAC ID 4688586829, shared by 8 NPIs, 49 clinicians

Montgomery County Memorial HospitalGroup PAC ID 9032015805, shared by 7 NPIs, 43 clinicians

Sports Rehab and Professional Therapy Associates IncGroup PAC ID 1658289608, 124 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Anthony Regional Hospital & Nursing Home Hospital, Carroll, IA, CCN 161382
• Montgomery County Memorial Hospital Hospital, Red Oak, IA, CCN 161363
• Buena Vista Regional Medical Center Hospital, Storm Lake, IA, CCN 161375
• Humboldt County Memorial Hospital Hospital, Humboldt, IA, CCN 161334
• Pocahontas Community Hospital Hospital, Pocahontas, IA, CCN 161305

Merit-based Incentive Payment System (MIPS)

Final score

92.6 of 100Reported as apm

Quality

82.13

Promoting interoperability

100

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

95.38 of 100Reported as individual

Quality

90.77

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

84.59 of 100Reported as group

Quality

90

Promoting interoperability

84

Improvement activities

40

Cost

71.97

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: twellendorf158570@direct.unitypoint.org
• Direct secure messaging: tgwellendorf@cynchealthdsm.org
• Direct secure messaging: twellendorf@wellendorfent.gwaydirect.com
• Direct secure messaging: twellendorf117448@uihcdirect.org

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.

• Wellendorf ENT, P.C.

  • Otolaryngology Physician
  • Carroll, IA
  • NPI 1740494244
  Medicare reassignment Authorized official
• Montgomery County Memorial Hospital

  • Internal Medicine Physician
  • Red Oak, IA
  • NPI 1265405310
  Medicare reassignment NPD
• Montgomery County Memorial Hospital

  • Critical Access Hospital
  • Red Oak, IA
  • NPI 1376539338
  Medicare reassignment NPD
• St Anthony Regional Hospital and Nursing Home

  • Critical Access Hospital
  • Carroll, IA
  • NPI 1720067127
  Medicare reassignment NPD
• St Anthony Regional Hospital and Nursing Home

  • Family Medicine Physician
  • Carroll, IA
  • NPI 1801815972
  Medicare reassignment NPD
• Sports Rehab and Professional Therapy Associates Inc

  • Rehabilitation Clinic/Center
  • Storm Lake, IA
  • NPI 1033289749
  Care Compare group
• Montgomery County Memorial Hospital

  • Community/Retail Pharmacy
  • Red Oak, IA
  • NPI 1699887547
  NPD
• St Luke'S Methodist Hospital

  • General Acute Care Hospital
  • Cedar Rapids, IA
  • NPI 1083708226
  NPD
• Western Iowa Surgery Inc

  • Surgery Physician
  • Carroll, IA
  • NPI 1073713111
  NPD (past)

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

• Buena Vista Regional Medical Center

  • Critical Access Hospital
  • Storm Lake, IA
  • NPI 1134191653
  Care Compare affiliation
• Humboldt County Memorial Hospital

  • Critical Access Hospital
  • Humboldt, IA
  • NPI 1194702977
  Care Compare affiliation
• Montgomery County Memorial Hospital

  • Critical Access Hospital
  • Red Oak, IA
  • NPI 1376539338
  Care Compare affiliation
• Pocahontas Community Hospital

  • Critical Access Hospital
  • Pocahontas, IA
  • NPI 1346241213
  Care Compare affiliation
• St Anthony Regional Hospital and Nursing Home

  • Critical Access Hospital
  • Carroll, IA
  • NPI 1720067127
  Care Compare affiliation

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

{
    "created_epoch": "1129248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553472000000",
    "number": "1528057387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 766",
            "city": "CARROLL",
            "state": "IA",
            "postal_code": "514010766",
            "telephone_number": "712-792-4368",
            "fax_number": "712-792-4351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 S CLARK ST",
            "address_2": "SUITE 215",
            "city": "CARROLL",
            "state": "IA",
            "postal_code": "514013065",
            "telephone_number": "712-792-4368",
            "fax_number": "712-792-2056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELLENDORF",
        "first_name": "TRACEY",
        "middle_name": "G",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-14",
        "last_updated": "2019-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IA",
            "license": "30594",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3124032",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5124032",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1124032",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6124032",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2124032",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jwellendorf@wellendorfent.com",
            "affiliation": "N",
            "endpointDescription": "Office email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1124 W 20th St",
            "city": "Carroll",
            "state": "IA",
            "country_code": "US",
            "postal_code": "514013357",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Luann Walsh
• Rosemary C Watchorn, MS, RD, LD
• Katrina (Tina) K Wederquist Zanders, MS, LMSW
• Dorinda Wehde, MS, CADC
• Wellendorf ENT, P.C.
• Catherine A Wernimont, RD LD
• Matthew Thomas Wessling, ARNP
• Kellie A Westercamp, RD
• Western Iowa Sleep Inc
• Western Iowa Surgery Inc

• Otolaryngology Physician in Carroll, IA
• Providers in Carroll, IA by specialty
• Otolaryngology Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2019; 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.