NPIMap

Individual provider Active NPI

Dustin Robert Pratt, M.D.

  • Family Medicine Physician
  • Childress, TX
National Provider Identifier
1912199456
Registry record updated Jan 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M6834 Issued in TX
Practice address
1001 Highway 83 North
Childress, TX 79201-1030
Phone
(940) 937-3636
NPI assigned
Aug 17, 2007
Last updated
Jan 12, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 12, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X
Family Medicine Physician 207Q00000X M6834 TX Primary

Addresses

Primary practice location

1001 Highway 83 North
Childress, TX 79201-1030

Mailing address

1001 US Highway 83 N
Childress, TX 79201-2322
Phone (940) 937-3636

Other identifiers 1

IdentifierTypeStateIssuer
196752301MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080818000229 TX Practitioner - Family Practice 2466527007 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Texas Tech University Health Science Center School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1 Medical Dr
Clarendon, TX 79226-6046
Phone (806) 874-3531

1001 US Hwy 83 N
Childress, TX 79201-2322
Phone (940) 937-3636

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M6834TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Clarendon Family Medicine PLLC CurrentSince Oct 12, 2022 Accepting new patients
Clarendon Family Medicine PLLC CurrentSince Feb 25, 2023 Accepting new patients
Donley County RHC Corporation CurrentSince Nov 1, 2022 Accepting new patients
Childress County Hospital District CurrentSince Jun 28, 2018 Accepting new patients
Stonewall Memorial Hospital Past Accepting new patients
Childress County Hospital District Past Accepting new patients

Locations

901 US Highway 83 N
Childress, TX 79201
Phone (940) 937-6371

1 Medical Dr
Clarendon, TX 79226
Phone (806) 874-2244

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Clarendon Family Medicine, PLLCClarendon, TX, CCN 678929 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 12, 2022
Oct 12, 2022

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1187308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673481600000",
    "number": "1912199456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 US HIGHWAY 83 N",
            "city": "CHILDRESS",
            "state": "TX",
            "postal_code": "792012322",
            "telephone_number": "940-937-3636",
            "fax_number": "940-937-9644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 HIGHWAY 83 NORTH",
            "city": "CHILDRESS",
            "state": "TX",
            "postal_code": "792011030",
            "telephone_number": "940-937-3636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRATT",
        "first_name": "DUSTIN",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-17",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "M6834",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "196752301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Childress, TX

Sources for this page

Verify at the official NPI Registry.