Keri Jo Wellborn, MD
Individual provider Active NPI Family Medicine Physician · Childress, TX
NPI 1972915775 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1972915775
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- Q7030 (TX)
- Practice address
- 1001 US Highway 83 N
Childress, TX 79201-2322 - Phone
- (940) 937-3636
- Fax
- (940) 937-9615
- NPI assigned
- May 28, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 20
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Texas Tech University Health Science Center School of Medicine, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Childress County Hospital District
Practice addresses (Care Compare)
1001 US Hwy 83 N
Childress, TX 79201-2322
Phone (940) 937-3636
Hospital & facility affiliations
- Childress Regional Medical Center Hospice
- Childress Regional Medical Center
- Bsa Hospital
- Collingsworth General Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160317001757 | TX | Practitioner - Family Practice | 3779880760 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Childress County Hospital District | Past | Accepting new patients | |
| Jackson County Memorial Hospital Authority | Past | Accepting new patients | |
| Childress County Hospital District | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Q7030 | TX | Yes |
Addresses
Primary practice location
1001 US Highway 83 N
Childress, TX 79201-2322
Mailing address
PO Box 1030
Childress, TX 79201-1030
Phone (940) 937-3636
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 355764703 | Medicaid | TX | |
| Q7030 | Other | TX | TEXAS MEDICAL BOARD |
Other providers in Childress, TX
- Terry W Thompson
- Amanda Jo Browning Tucker
- Turner Nursing and Rehabilitation LP
- United Supermarkets LLC
- Wal-Mart Stores Texas LLC
- Jerry Steven Young
All providers in Childress, TX · Family Medicine Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.