Jerry David Whatley, MD

Primary specialty

Adolescent Medicine (Family Medicine) PhysicianTaxonomy code 207QA0000X

License

19096 Issued in OK

Practice address

509 Grand Ave
Ardmore, OK 73401-4338

Phone

(580) 223-3300

Fax

(580) 223-3320

NPI assigned

May 11, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in OK

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

Pediatric Medicine

Education

Other, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northeastern Oklahoma Community Health Centers, IncGroup PAC ID 3678482635, 38 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

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.

• Northeastern Oklahoma Community Health Centers Inc

  • Federally Qualified Health Center (FQHC)
  • Hulbert, OK
  • NPI 1518070481
  Medicare reassignment Care Compare group NPD
• Doctor Feel Good LLC

  • Pediatrics Physician
  • Muskogee, OK
  • NPI 1558290304
  NPD Authorized official
• Northeastern Oklahoma Community Health Centers Inc

  • Federally Qualified Health Center (FQHC)
  • Pryor, OK
  • NPI 1669101184
  NPD
• Northeastern Oklahoma Community Health Centers, Inc

  • Federally Qualified Health Center (FQHC)
  • Muskogee, OK
  • NPI 1942553946
  NPD
• Saint Francis Hospital Muskogee Inc

  • General Acute Care Hospital
  • Muskogee, OK
  • NPI 1386188837
  NPD (past)

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294358400000",
    "number": "1780634816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "936 DEESE RD",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734019315",
            "telephone_number": "580-224-9035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 GRAND AVE",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734014338",
            "telephone_number": "580-223-3300",
            "fax_number": "580-223-3320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHATLEY",
        "first_name": "JERRY",
        "middle_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2011-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0000X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adolescent Medicine",
            "state": "OK",
            "license": "19096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOONERCARE MCD #",
            "identifier": "100114070G",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OKLAHOMA LICENSE #",
            "identifier": "19096",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID #",
            "identifier": "731612230",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100114070A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wadonna Wells, LADC
• Shelby Wesley
• Tammy Marie West, MS
• Lacy Diane Westfall, APRN-CNP
• Katie Rae Ann Weston, B.A.
• Mikella A Whatley
• Danielle Wheat, PA-C
• Daniel Ryan Wheeler, D.O.
• Lisa M. Whertvine, M.S.,LPC
• Sherry White, BA

• Adolescent Medicine (Family Medicine) Physician in Ardmore, OK
• Providers in Ardmore, OK by specialty
• Adolescent Medicine (Family Medicine) Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 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.
• 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.