Wallace W Weatherly, M.D.

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

11796 Issued in MS

Practice address

1801 Crane Ridge Dr
Suite C
Jackson, MS 39216-4902

Phone

(601) 981-5633

Fax

(601) 981-1844

NPI assigned

May 23, 2006

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

Medicare fee-for-service enrollment

Enrolled in MS, TX2 enrollments

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 2

Specialty

Orthopedic Surgery

Education

University of Mississippi School of Medicine, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Discovery Medical Network Sweetwater LLCGroup PAC ID 6608025176, 9 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Rolling Plains Memorial Hospital Hospital, Sweetwater, TX, CCN 450055
• Mitchell County Hospital District Hospital, Colorado City, TX, CCN 451342
• Cogdell Memorial Hospital Hospital, Snyder, TX, CCN 451384

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: weatherly_wallace_md@yourcarecommunity.org

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.

• Discovery Medical Network Sweetwater LLC

  • Orthopaedic Surgery Physician
  • Sweetwater, TX
  • NPI 1134485550
  Medicare reassignment Care Compare group NPD
• Bolivar Physician Practices LLC

  • Orthopaedic Surgery Physician
  • Cleveland, MS
  • NPI 1063659530
  Medicare reassignment NPD
• Bolivar Physician Practices LLC

  • Family Medicine Physician
  • Cleveland, MS
  • NPI 1043454655

  Orthopaedic Surgery

  NPD
• Bolivar Physician Practices LLC

  • Rural Health Clinic/Center
  • Rosedale, MS
  • NPI 1205489689
  NPD
• Ques Transport LLC

  • Ambulance
  • Spencer, VA
  • NPI 1023850328
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mitchell County Hospital District

  • Critical Access Hospital
  • Colorado City, TX
  • NPI 1184631673
  Care Compare affiliation
• Rolling Plains Memorial Hospital

  • General Acute Care Hospital
  • Sweetwater, TX
  • NPI 1275581852
  Care Compare affiliation
• Scurry County Hospital District

  • Critical Access Hospital
  • Snyder, TX
  • NPI 1578588463
  Care Compare affiliation

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513641600000",
    "number": "1972558542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907 E SUNFLOWER RD",
            "address_2": "STE 102",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "387322830",
            "telephone_number": "662-843-8885",
            "fax_number": "662-843-2280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 CRANE RIDGE DR",
            "address_2": "SUITE C",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164902",
            "telephone_number": "601-981-5633",
            "fax_number": "601-981-1844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEATHERLY",
        "first_name": "WALLACE",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2017-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MS",
            "license": "11796",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• We Care Home Healthcare, LLC
• We Care Home Services, LLC
• Weatherly Sports Medicine & Family Orthopaedics, PA
• Brandon B Weatherly, M.D.
• Lyssa Taylor Weatherly, M.D.
• Coronda Weathersby
• Courtney Weathersby
• Kenya Delisa Weatherspoon, OT
• Weave and Beyond LLC
• Cynthia Weaver

• Orthopaedic Surgery Physician in Jackson, MS
• Providers in Jackson, MS by specialty
• Orthopaedic Surgery Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2017; 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.