John Derek Wisdom, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

7361 Issued in TX

Practice address

1018 E Goode St Ste 102
Quitman, SD 75783

Phone

(903) 763-4404

Fax

(903) 763-2550

NPI assigned

Jan 10, 2007

Last updated

Jan 12, 2024By the provider in NPPES

Sex

Male

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 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Specialty

Chiropractic

Education

Other, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Quitman Health Services PLLCGroup PAC ID 6800034331, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Quitman Health Services, PLLC

  dba Quitman Chiropractic and Acupuncture

  • Physical Therapist
  • Quitman, TX
  • NPI 1902032402

  Chiropractor

  Medicare reassignment Care Compare group NPD Authorized official
• Scott's Quitman Pharmacy, LLC

  • Pharmacy
  • Quitman, TX
  • NPI 1477981512
  NPD (past)

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705017600000",
    "number": "1942359658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1018 E GOODE ST STE 102",
            "city": "QUITMAN",
            "state": "TX",
            "postal_code": "75783",
            "telephone_number": "903-763-4404",
            "fax_number": "903-763-2550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1018 E GOODE ST STE 102",
            "city": "QUITMAN",
            "state": "SD",
            "postal_code": "75783",
            "telephone_number": "903-763-4404",
            "fax_number": "903-763-2550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISDOM",
        "first_name": "JOHN",
        "middle_name": "DEREK",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-10",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "7361",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0020166-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.