HATTIE JILL FEETHAM (M.D.) – Dermatology Physician, NPI 1780942474

HATTIE JILL FEETHAM (M.D.) is a healthcare provider. based in Southlake, Texas. specializing in DERMATOLOGY. They hold the professional credentials M.D.. They hold a License No. 565428 (TX). The NPI Number for HATTIE JILL FEETHAM (M.D.) is 1780942474

Main info

Female
14 Years Of Experience
Accepts Medicare Assignment
Name
HATTIE JILL FEETHAM (M.D.)
NPI
1780942474
Phone
(817) 251-6500
Address
1170 N CARROLL AVE
Enumeration Date
1 May 2012
Last Update Date
26 July 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2146317546
Graduation Year
2012 (14 years ago)
PAC ID
3173813185
Group Practice PAC ID
8325344385
Professional Enrollment ID
I20160603000811
Address ID
TX752256225DA8201XRDXX301
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience52
Completeness75
Years active:14State licenses:1Digital endpointsOther names

1,287 DERMATOLOGY in TX

Provider Addresses for HATTIE JILL FEETHAM (M.D.)

  • 1170 N CARROLL AVE

    SOUTHLAKE, TX 760925306

    Phone: (817) 251-6500

    Type: Mailing

  • 8201 PRESTON RD STE 350

    DALLAS, TX 752256225

    Phone: (214) 631-7546

    Fax: (214) 631-8546

    Type: Mailing

  • 601 E 15th St # C2.443

    CEC C2.443

    Austin, TX 787011930

    Phone: (512) 324-7997

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 88 Open Payments records for all available years, with a total value of $3,094.

Total Amount is formed as General ($3,094) + Research ($0) + Ownership ($0) = $3,094.

Last reported payment date: 2024-12-12 • Largest payer in this snapshot: Solta Medical, a division of Bausch Health US, LLC ($1,500).

Total Amount

$3,094

General + Research + Ownership

Payments

88

Total payment records

General Amount

$3,094

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-12

Latest reported date

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2016-06-03

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20160603000811IDermatologyTXTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
17003Destruction of precancer skin growth, 2-14 growths834129$0
99213Established patient office or other outpatient visit, 20-29 minutes491309$0
17000Destruction of precancer skin growth, 1 growth252165$0
17110Destruction of skin growth, 1-14 growths168134$0
11102Biopsy of related skin growth, first growth145114$0
View full utilization report →

Insurance plans in this area (ZIP 76092)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 8325344385View full group profile
NameSpecialtyState
D E R M A T O L O G YTX
D E R M A T O L O G YTX

Reviews

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Frequently asked questions

Does HATTIE JILL FEETHAM (M.D.) have a public NPI I can cite?
Public records show HATTIE JILL FEETHAM (M.D.) under NPI 1780942474.
Should I treat HATTIE JILL FEETHAM (M.D.) as an active provider?
Patients and plans typically see HATTIE JILL FEETHAM (M.D.) as active in the national extract.
How should patients interpret HATTIE JILL FEETHAM (M.D.)'s specialty?
The extract shows Dermatology Physician for HATTIE JILL FEETHAM (M.D.). Clinical services aligned with this taxonomy classification.
What geographic area is tied to HATTIE JILL FEETHAM (M.D.)?
HATTIE JILL FEETHAM (M.D.) is associated with Southlake, Texas in the same public data insurers reference.
Why is information missing for HATTIE JILL FEETHAM (M.D.)?
Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.

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