Waterford Family Medicine PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

1093794968 Issued in IA

Legal business name

WATERFORD FAMILY MEDICINE PC

Practice address

1820 E 54TH St
Ste B
Davenport, IA 52807-2797

Phone

(563) 355-9990

Fax

(563) 355-9999

NPI assigned

Mar 6, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Tammy J Wells, M.D.NPI 1093794968

Title

Owner

Phone

(563) 355-9990

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 4

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

• Tammy Jo Wells, MD

  • Family Medicine Physician
  • Davenport, IA
  • NPI 1093794968
  Medicare reassignment Care Compare group NPD Authorized official
• Cammie A Davis, FNP

  • Family Nurse Practitioner
  • Davenport, IA
  • NPI 1518054436
  Medicare reassignment Care Compare group NPD
• Justice Lyric Humphrey, MSN, ARNP, FNP-C

  • Family Nurse Practitioner
  • Davenport, IA
  • NPI 1528875192
  Medicare reassignment NPD
• Valerie Lynne Bonnett, M.D.

  • Family Medicine Physician
  • Pella, IA
  • NPI 1023097912
  NPD (past)

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

{
    "created_epoch": "1204761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204761600000",
    "number": "1942470828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1820 E 54TH ST",
            "address_2": "STE B",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528072797",
            "telephone_number": "563-355-9990",
            "fax_number": "563-355-9999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1820 E 54TH ST",
            "address_2": "STE B",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528072797",
            "telephone_number": "563-355-9990",
            "fax_number": "563-355-9999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERFORD FAMILY MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-06",
        "last_updated": "2008-03-06",
        "status": "A",
        "authorized_official_last_name": "WELLS",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "563-355-9990",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "1093794968",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "49490",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100883",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Breanna Lynn Ward
• Robert Jack Scott Ward, DC
• Karyn M Warford, LCSW, LISW
• Mallory Warner, DC
• Kendria Warren
• Cari Waterkotte, ARNP
• Agnes Waterstreet, PSY.D
• Jasmine Elise Watson, PTA
• Koresha Watson
• Laura Watts

• Family Medicine Physician in Davenport, IA
• Providers in Davenport, IA by specialty
• Family Medicine Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2008; 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.