Beverly L Waddleton, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G0244 Issued in TX

Practice address

108 Parker St
Ste.300
Quitman, TX 75783-2102

Phone

(903) 763-6220

Fax

(903) 763-6222

NPI assigned

Jun 23, 2006

Sex

Female

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 2

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, 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.

• Etmc Physician Group Inc.

  • Cardiovascular Disease Physician
  • Tyler, TX
  • NPI 1609382662

  TX

  Medicare reassignment NPD
• Quitman Hospital LLC

  • Certified Registered Nurse Anesthetist
  • Quitman, TX
  • NPI 1629571773

  TX

  Medicare reassignment NPD
• Etmc Physician Group Inc.

  • Rural Health Clinic/Center
  • Chandler, TX
  • NPI 1235706581
  NPD
• Quitman Hospital LLC

  • Critical Access Hospital
  • Quitman, TX
  • NPI 1477061885
  NPD
• Starks Medical

  • Primary Care Nurse Practitioner
  • Bullard, TX
  • NPI 1306570593
  NPD (past)

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307059200000",
    "number": "1629004684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9477",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757119477",
            "telephone_number": "903-594-2450",
            "fax_number": "903-509-0493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 PARKER ST",
            "address_2": "STE.300",
            "city": "QUITMAN",
            "state": "TX",
            "postal_code": "757832102",
            "telephone_number": "903-763-6220",
            "fax_number": "903-763-6222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADDLETON",
        "first_name": "BEVERLY",
        "middle_name": "L",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-23",
        "last_updated": "2011-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "G0244",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "P00222535",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "120495005",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrew Tarbutton, FNP-C
• Rowdy Scott Teaff, DC
• Teri Curington Consulting, LLC
• Suzanne Dawson Terrell, FNP
• Kimberly A Vogel, DO
• Walgreen Co
• Wesley Partners, LTD.
• Kelly Whiddon
• Tracy Lynn Whinery, NP
• Winnsboro Isd

• All providers in Quitman, TX
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2011; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.