B Waldo MD LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

B WALDO MD LLC

Practice address

3000 Pepper Creek Bridge Pkwy
Valparaiso, IN 46385-7129

Phone

(773) 520-1950

NPI assigned

Jun 9, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Bryan E Waldo, MDNPI 1982716486

Title

Owner

Phone

(773) 520-1950

Specialties & licenses 1

Addresses

Other names 1

• NA Other name

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bryan Waldo, M.D.

  • Nephrology Physician
  • Valparaiso, IN
  • NPI 1982716486

  Internal Medicine

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1686268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686268800000",
    "number": "1043994262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 PEPPER CREEK BRIDGE PKWY",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463857129",
            "telephone_number": "773-520-1950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 PEPPER CREEK BRIDGE PKWY",
            "city": "VALPARAISO",
            "state": "IN",
            "postal_code": "463857129",
            "telephone_number": "773-520-1950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "B WALDO MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-09",
        "last_updated": "2023-06-09",
        "certification_date": "2023-06-09",
        "status": "A",
        "authorized_official_last_name": "WALDO",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-520-1950",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Internal Medicine Physician in Valparaiso, IN
• Providers in Valparaiso, IN by specialty
• Internal Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.