Wanda M Northam, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

J0619 Issued in TX

Practice address

4800 Texas Blvd Ste 100
Texarkana, TX 75503-3033

Phone

(318) 222-8421

Fax

(318) 673-9972

NPI assigned

Jul 28, 2005

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

Specialty

Ophthalmology

Education

University of Texas Medical School at San Antonio, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Charles E Lyon, MD, ApmcGroup PAC ID 1850370099, 3 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

97.81 of 100Reported as group

Quality

95.63

Improvement activities

40

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.

• Charles E Lyon, MD, Apmc

  • Optometrist
  • Shreveport, LA
  • NPI 1689789562

  Ophthalmology, TX

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609372800000",
    "number": "1780684183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5002 COWHORN CREEK RD",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755039766",
            "telephone_number": "318-222-8421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 TEXAS BLVD STE 100",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755033033",
            "telephone_number": "318-222-8421",
            "fax_number": "318-673-9972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NORTHAM",
        "first_name": "WANDA",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-28",
        "last_updated": "2020-12-31",
        "certification_date": "2020-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "TX",
            "license": "J0619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119308001",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "047789501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daphnee Noel, MD
• Madilynn Nolen
• Savannah Norman, DC
• Norris Knight MD Orthopedics
• Jon M Northam, MD
• Northeast Texas Mental Health Mental Retardation Center
• Northeast Texas Surgery Center
• Northland Hearing Centers Inc
• Gaylyn Norwood
• Nursing in the Spirit Outreach Ministries

• Ophthalmology Physician in Texarkana, TX
• Providers in Texarkana, TX by specialty
• Ophthalmology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2020; 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.