Individual provider Active NPI

Amy Reyne Wentworth-Kotara, PA-C

  • Physician Assistant
  • Dallas, TX
National Provider Identifier
1639200231
Registry record updated Aug 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA05178 Issued in TX
Practice address
2001 Inwood Rd
Dallas, TX 75390
Phone
(214) 645-2800
NPI assigned
Mar 8, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA05178 TX Primary

Addresses

Primary practice location

2001 Inwood Rd
Dallas, TX 75390

Mailing address

PO Box 845347
Dallas, TX 75284-7208
Phone (214) 645-2800

Other practice location 1

4118 Pond Hill Rd Bldg 3
Shavano Park, TX 78231-1281
Phone (210) 494-3739 ext. 105

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070807000291 TX Practitioner - Physician Assistant 3476644352 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Texas Southwestern Medical Center at DallasGroup PAC ID 0648188250, 3,156 clinicians

Practice addresses (Care Compare)

2001 Inwood Rd
Dallas, TX 75390-7202

2201 Inwood Rd
Dallas, TX 75235-7320
Phone (214) 645-2700

3000N Interstate 35
Denton, TX 76201-5119
Phone (469) 303-3591

5323 Harry Hines Blvd
Dallas, TX 75390-9257

Hospital & facility affiliations

  • Ut of Texas Southwestern University Hospital - William P. Clements Jr. Hospital, Dallas, TX, CCN 450044

Merit-based Incentive Payment System (MIPS)

Final score
82.87 of 100Reported as group
Quality
70.15
Promoting interoperability
100
Improvement activities
40
Cost
72.75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Texas Southwestern Medical Center at Dallas CurrentSince Jul 15, 2019 Accepting new patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Jul 15, 2019 Accepting new patients
Magella Medical Associates Billing, Inc. Past Accepting new patients
University of Texas Southwestern Medical Center at Dallas Past Accepting new patients
Ramon Garza MD PA Past Accepting new patients

Locations

2201 Inwood Rd
Dallas, TX 75235
Phone (214) 645-2563

5151 Harry Hines Blvd
Dallas, TX 75235
Phone (214) 590-3000

6201 Harry Hines Blvd
Dallas, TX 75235
Phone (214) 633-4700

3000 N Interstate 35
Denton, TX 76201
Phone (469) 303-3591

5323 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390

2001 Inwood Rd
Ut Southwest Medical Center, TX 75390
Phone (214) 645-8000

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566172800000",
    "number": "1639200231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 845347",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752847208",
            "telephone_number": "214-645-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 INWOOD RD",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75390",
            "telephone_number": "214-645-2800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4118 Pond Hill Rd Bldg 3",
            "address_purpose": "LOCATION",
            "city": "Shavano Park",
            "state": "TX",
            "postal_code": "782311281",
            "country_code": "US",
            "telephone_number": "210-494-3739 x105",
            "fax_number": "210-490-2164",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WENTWORTH-KOTARA",
        "first_name": "AMY",
        "middle_name": "REYNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-08",
        "last_updated": "2019-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA05178",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.