Active NPI
Jared Waters
- Physician Assistant
- Roanoke, VA
National Provider Identifier
1023701927
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0110009479
- Practice address
- 5673 Airport Rd
Roanoke, VA 24012-1119 - Phone
- (540) 523-8080
- NPI assigned
- May 29, 2023
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0110009479 | VA | Primary |
Addresses
Primary practice location
5673 Airport Rd
Roanoke, VA 24012-1119
Mailing address
3111 Grayland Ave
Richmond, VA 23221-3527
Other practice location 1
5500 Staples Mill Rd
Henrico, VA 23228-5423
Phone (540) 523-8080
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- University of Florida College of Medicine, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
5673 Airport Rd
Roanoke, VA 24012-1119
Phone (540) 523-8055
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0110009479 | VA | MD | Physician Assistant |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Addiction Psychiatry Physician
- Roanoke, VA
- NPI 1730608217
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1685318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692230400000",
"number": "1023701927",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3111 GRAYLAND AVE",
"city": "RICHMOND",
"state": "VA",
"postal_code": "232213527"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5673 AIRPORT RD",
"city": "ROANOKE",
"state": "VA",
"postal_code": "240121119",
"telephone_number": "540-523-8080"
}
],
"practiceLocations": [
{
"address_1": "5500 Staples Mill Rd",
"address_purpose": "LOCATION",
"city": "Henrico",
"state": "VA",
"postal_code": "232285423",
"country_code": "US",
"telephone_number": "540-523-8080",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WATERS",
"first_name": "JARED",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-05-29",
"last_updated": "2023-08-17",
"certification_date": "2023-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "VA",
"license": "0110009479",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roanoke, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2023; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.