NPIMap

Organization Active NPI

Northwest Texas Wyatt Clinic PLLC

  • Internal Medicine Physician
  • Amarillo, TX
National Provider Identifier
1780008904
Registry record updated Jun 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
NORTHWEST TEXAS WYATT CLINIC PLLC
Practice address
1411 E Amarillo Blvd
Amarillo, TX 79107-5555
Phone
(806) 354-1015
NPI assigned
Feb 7, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2019

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

Authorized official

Name
Todd Evans
Title
VP
Phone
(610) 768-3300

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

1411 E Amarillo Blvd
Amarillo, TX 79107-5555

Mailing address

367 S Gulph Rd
King of Prussia, PA 19406-3121

Other identifiers 2

IdentifierTypeStateIssuer
DV2201OtherTXRR MEDICARE
3393704 01MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140805000346 TX Part B Supplier - Clinic/Group Practice 8224255997 Receives reassigned benefits from 14 practitioners
Practice locations: Amarillo, TX

National Provider Directory

National Provider Directory

Locations

367 S Gulph Rd
Kng of Prussa, PA 19406
Phone (610) 382-4422

6900 W Interstate 40
Ste 285
Amarillo, TX 79106
Phone (806) 354-9540

1900 SE 34th Ave
Unit 1700
Amarillo, TX 79118
Phone (806) 351-7530

1900 SE 34th Ave
Unit 1800
Amarillo, TX 79118
Phone (806) 351-7540

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1391731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561593600000",
    "number": "1780008904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "367 S GULPH RD",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194063121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 E AMARILLO BLVD",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791075555",
            "telephone_number": "806-354-1015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST TEXAS WYATT CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-07",
        "last_updated": "2019-06-27",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "610-768-3300"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DV2201",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3393704 01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Amarillo, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.