JAMES R QUALLS DO
NPI 1407141120
Family Medicine in Athens, TX

Q: What is James Qualls's NPI number?

The NPI number for James Qualls is 1407141120. It was assigned to this individual provider in the NPPES registry on June 10, 2011.

Q: What is James Qualls's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Q: When was this NPI record last updated?

The NPPES record for James Qualls was last updated on May 12, 2021. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since June 10, 2011PECOS EnrolledAccepts Medicare Assignment

1505 STATE HIGHWAY 19 S, ATHENS, TX 75751(903) 675-1725 Get Directions Write a Review

NPPES record last updated: May 12, 2021. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: May 12, 2021, Mar 31, 2021, Mar 18, 2021 (3 updates tracked since 2021).

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About James R Qualls Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JAMES R QUALLS DO (NPI 1407141120) is an individual family medicine provider in Athens, Texas, licensed in Texas (P0656) and active in the NPI registry since June 2011. He is enrolled in Medicare PECOS, is affiliated with Christus Mother Frances Hospital, and maintains a secondary practice location in Athens.

NPPES Registry Identity

NPI1407141120

Entity TypeIndividualMale

Primary Taxonomy207Q00000X

Provider Legal NameJAMES R QUALLSCredential: DO

Location Address1505 STATE HIGHWAY 19 SAthens, TX 75751-8950

Mailing Address115 Medical Cir, Suite 100Athens, TX 75751-9124 · (903) 675-5744 · Fax (903) 675-5677

Phone(903) 675-1725

Sole ProprietorNo

Medical School CMSUniversity Of North Texas Hsc, College Of Osteopathic MedGraduated 2010

Enumeration DateJune 10, 2011

Last NPPES UpdateMay 12, 20213 updates tracked since enumeration

NPPES CertifiedMay 12, 2021

✔ NPI 1407141120 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Licenses✔ Licensed in TX · P0656✔ Licensed in TX · BP10038570

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

1505 STATE HIGHWAY 19 S, Athens, TX 75751

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Secondary Practice Location 1

Location 1115 Medical Cir, Suite 100Athens, TX 75751-9124 · Phone (903) 675-5744 · Fax (903) 675-5677

Other Identifiers 3

Other1L8412TX · Medicare

Medicaid324380002TX

OtherP02604877TX · Rr Mcr

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Texas, CHRISTUS Health Plan, UnitedHealthcare.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

James R Qualls Do is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4789829573

PECOS Enrollment IDI20130327000348

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 8

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

822 services285 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

235 services172 patients

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439

An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.

229 services229 patients

Physician or allowed practitioner re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians a G0179

This procedure involves a doctor or approved practitioner reviewing your health status and re-certifying your need for Medicare-covered home health services. It includes communication with the home health agency and assessment of your health reports, even when you're not physically present.

50 services22 patients

Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and G0180

This is a service where a doctor or authorized practitioner certifies that you require Medicare-covered home health services. They will communicate with the home health agency and review reports on your health status to ensure you receive appropriate care. This does not involve an in-person visit.

28 services27 patients

Transitional care management services for problem of at least moderate complexity 99495

Transitional care management services focus on coordinating and managing your care after you leave the hospital. For moderate complexity problems, this involves managing your medications, arranging further treatments, and ensuring you have the necessary follow-ups.

23 services18 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Christus Mother Frances Hospital

Acute Care Hospitals · Tyler, TX

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number450102

Location800 East DawsonTyler, TX 75701 · Smith County

Emergency services Birthing friendly

Ut Health East Texas Athens Hospital

Acute Care Hospitals · Athens, TX

2/5 CMS rating

OwnershipProprietary

CMS Certification Number450389

Location2000 South Palestine StAthens, TX 75751 · Henderson County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 75751 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$84.92 typical visit price

range $54.84 – $166.88

Typical copayment $21.23 (range $13.71 – $41.72)

Most-billed visit code 99203

Established Patient

$97.05 typical visit price

range $17.52 – $136.11

Typical copayment $24.26 (range $4.38 – $34.02)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

Reported Quality Measures

e-Prescribing

At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.

97%3,394 patients4/55-star benchmark: 99%

Health Information Exchange

The MIPS eligible clinician that transitions or refers their patient to another setting of care or health care clinician (1) uses CEHRT to create a summary of care record; and (2) electronically transmits such summary to a receiving health care clinician for…

71%364 patients4/55-star benchmark: 88%

Medication Reconciliation

The MIPS eligible clinician performs medication reconciliation for at least one transition of care in which the patient is transitioned into the care of the MIPS eligible clinician.

99%158 patients4/55-star benchmark: 100%

Patient-Specific Education

The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.

64%1,027 patients3/55-star benchmark: 97%

Provide Patient Access

At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold…

53%1,027 patients3/55-star benchmark: 100%

Secure Messaging

For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure…

7%1,027 patients1/55-star benchmark: 89%

View, Download, or Transmit (VDT)

At least one patient seen by the MIPS eligible clinician during the performance period (or patient-authorized representative) views, downloads or transmits their health information to a third party during the performance period.

28%1,027 patients

Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Referred Medical Equipment & Supplies CMS DME claims 13

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253

DME-Other DME · category DE017N

7 suppliers23 claims70 services$6.82 avg. paid by Medicare

Lancets, per box of 100 A4259

DME-Medical/Surgical Supplies · category DA000N

5 suppliers12 claims16 services$1.20 avg. paid by Medicare

Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each A4351

DME-Orthotic Devices · category DF008N

2 suppliers19 claims3,800 services$1.71 avg. paid by Medicare

Lubricant, per ounce A4402

DME-Orthotic Devices · category DF010N

1 supplier12 claims48 services$1.54 avg. paid by Medicare

Administration set, with small volume nonfiltered pneumatic nebulizer, disposable A7003

DME-Other DME · category DE000N

2 suppliers21 claims42 services$1.65 avg. paid by Medicare

Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing E0431

DME-Oxygen and Supplies · category DC000N

2 suppliers31 claims38 services$18.62 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. TERRI LYNN ECKERT M.D.

Family Medicine