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WATERFORD FAMILY MEDICINE PC
NPI 1942470828
Family Medicine in Davenport, IA

Active since March 06, 2008CLIA 16D0963126 · Microscopy
1820 E 54TH ST, STE B, DAVENPORT, IA 52807(563) 355-9990(563) 355-9999 Get Directions Write a Review

NPPES record last updated: March 6, 2008. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Waterford Family Medicine Pc NPPES

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

WATERFORD FAMILY MEDICINE PC (NPI 1942470828) is a healthcare organization registered as a family medicine in Davenport, Iowa and active in the NPI registry since March 2008. The organization holds a CLIA Microscopy certificate valid through July 22, 2027 and lists Tammy J Wells, Owner, as its authorized official.

NPPES Registry Identity

NPI1942470828
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameWATERFORD FAMILY MEDICINE PC
Location Address1820 E 54TH ST, STE BDavenport, IA 52807-2797
Mailing Address1820 E 54th St, Ste BDavenport, IA 52807-2797 · (563) 355-9990 · Fax (563) 355-9999
Phone(563) 355-9990
Fax(563) 355-9999
Organization SubpartNo
Authorized OfficialTammy J WellsOwner · (563) 355-9990
Enumeration DateMarch 6, 2008
✔ NPI 1942470828 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in IA · 1093794968
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.
1820 E 54TH ST, Davenport, IA 52807
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Other Identifiers 3

Medicare UPINI3990
Medicaid7100883IA
Other49490IA · Blue Shield

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Waterford Family Medicine Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Waterford Family Medicine PC, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 3 within 10 miles. They are listed nearest first.

Clinicians, nearest first (3)

Tammy Wells, MD
Family Practice
NPI 1093794968
1820 E 54TH ST SUITE B
Davenport, IA 52807
(563) 355-9990
✔ PECOS✔ Accepts MedicareSame address
Justice Humphrey, MSN, ARNP, FNP-C
Nurse Practitioner
NPI 1528875192
1820 E 54TH ST STE B
Davenport, IA 52807
(563) 355-9990
✔ PECOS0.1 mi
Cammie Davis, FNP
Nurse Practitioner
NPI 1518054436
1820 E 54TH ST STE B
Davenport, IA 52807
(563) 355-9990
✔ PECOS✔ Accepts Medicare0.1 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 16D0963126

Waterford Family Medicine · Davenport, IA
Active · expires Jul 22, 2027
CLIA Number16D0963126
Laboratory TypePhysician Office
Certificate Effective DateJuly 23, 2025
Certificate Expiration DateJuly 22, 2027
Laboratory DirectorTammy J. Wells
Laboratory Phone(563) 355-9990
Laboratory LocationWaterford Family Medicine1820 E 54th Street Suite B, Davenport, IA 52807
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Waterford Family Medicine PC's NPI number?

The NPI number for Waterford Family Medicine PC is 1942470828. It was assigned to this organization in the NPPES registry on March 6, 2008.

Where is Waterford Family Medicine PC located?

Waterford Family Medicine PC is located at 1820 E 54th St Ste B, Davenport, IA 52807. The listed phone number is (563) 355-9990.

What is Waterford Family Medicine PC's specialty?

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

Is Waterford Family Medicine PC enrolled in Medicare?

Yes. Waterford Family Medicine PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Waterford Family Medicine PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to Waterford Family Medicine PC, in Family Practice and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address and 3 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Waterford Family Medicine PC hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 16D0963126) is associated with this NPI, valid through July 22, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Waterford Family Medicine PC was last updated on March 6, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.