Samuel Jarratt Wiley, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

R4921 Issued in TX

Practice address

7601 Quaker Ave
Lubbock, TX 79424-3360

Phone

(806) 725-9444

Fax

(806) 725-9500

NPI assigned

Jun 23, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Covenant Medical GroupGroup PAC ID 6901889393, 228 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Covenant Medical Center Hospital, Lubbock, TX, CCN 450040
• Grace Surgical Hospital Hospital, Lubbock, TX, CCN 450162
• Covenant Childrens Hospital Hospital, Lubbock, TX, CCN 453306

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Covenant Medical Group

  • Family Medicine Physician
  • Lubbock, TX
  • NPI 1376598904

  Family Medicine, TX

  Medicare reassignment Care Compare group NPD
• Covenant Medical Group

  • Rural Health Clinic/Center
  • Abernathy, TX
  • NPI 1538412895

  Family Medicine

  NPD

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

• Covenant Medical Center

  • General Acute Care Hospital
  • Lubbock, TX
  • NPI 1972517365

  Hospital

  Care Compare affiliation
• Lubbock Heritage Hospital, LLC.

  • General Acute Care Hospital
  • Lubbock, TX
  • NPI 1225289499

  Hospital

  Care Compare affiliation
• Methodist Children'S Hospital

  • Children's Hospital
  • Lubbock, TX
  • NPI 1437171568

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1403481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1760897482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2215 NASHVILLE AVE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101105",
            "telephone_number": "806-725-5844",
            "fax_number": "806-723-6532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7601 QUAKER AVE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794243360",
            "telephone_number": "806-725-9444",
            "fax_number": "806-725-9500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1276 Fulton Ave",
            "address_2": "Bronx Lebanon Hospital,",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "10456",
            "country_code": "US",
            "telephone_number": "718-901-8294",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILEY",
        "first_name": "SAMUEL",
        "middle_name": "JARRATT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-23",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "R4921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Wiley
• Ashlyn Wiley
• Kendra Lea Wiley, FNP
• Kristopher F Wiley, RN
• Ladeivia Cherae Wiley, FNP-C
• Kellye Wilhite, M.ED., LPC, LCDC
• Angela Wilkerson, LCDC-I
• Lindsay Wilkerson, MS,CF/SLP
• Phyllis Wilkerson, NP-C
• David G Wilkins, DO

• Family Medicine Physician in Lubbock, TX
• Providers in Lubbock, 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 Mar 17, 2018; 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.