Active NPI
Philip E Walling, OD
- Optometrist
- Big Rapids, MI
National Provider Identifier
1003837733
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 4901003260
- Practice address
- 1124 S State St
Mco 101H
Big Rapids, MI 49307-2256 - Phone
- (231) 591-2020
- Fax
- (231) 591-3991
- NPI assigned
- Jul 21, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901003260 | MI | Primary |
Addresses
Primary practice location
1124 S State St
Mco 101H
Big Rapids, MI 49307-2256
Mailing address
1124 S State St
Mco 101H
Big Rapids, MI 49307-2256
Phone (231) 591-2020
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0784610001030 | Other | MI | ADMINISTAR |
| 4401699 | Medicaid | MI | |
| 999998001 | Other | MI | VSP |
| PW003260 | Other | MI | BLUE CROSS |
| 900006367 | Other | MI | PRIORITY HEALTH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348617600000",
"number": "1003837733",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1124 S STATE ST",
"address_2": "MCO 101H",
"city": "BIG RAPIDS",
"state": "MI",
"postal_code": "493072256",
"telephone_number": "231-591-2020",
"fax_number": "231-591-3991"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1124 S STATE ST",
"address_2": "MCO 101H",
"city": "BIG RAPIDS",
"state": "MI",
"postal_code": "493072256",
"telephone_number": "231-591-2020",
"fax_number": "231-591-3991"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLING",
"first_name": "PHILIP",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-21",
"last_updated": "2012-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MI",
"license": "4901003260",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ADMINISTAR",
"identifier": "0784610001030",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4401699",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VSP",
"identifier": "999998001",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "PW003260",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRIORITY HEALTH",
"identifier": "900006367",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Big Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2012; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.