Individual provider Active NPI

Walter Henry Halloran, MD

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Elkhart, IN
National Provider Identifier
1053486191
Registry record updated Mar 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
01039629 Issued in IN
Practice address
500 Arcade Ave Ste 230
Elkhart, IN 46514-2485
Phone
(574) 522-6565
Fax
(574) 522-5572
NPI assigned
Nov 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 01039629 IN Primary

Addresses

Primary practice location

500 Arcade Ave Ste 230
Elkhart, IN 46514-2485

Mailing address

710 N Niles Ave
South Bend, IN 46617-1924
Phone (574) 647-1610

Other identifiers 1

IdentifierTypeStateIssuer
100103250MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address HALLORAN@mybeacon.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100913000181 IN Practitioner - Thoracic SurgeryPractitioner - Cardiac Surgery 4789709924 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Thoracic Surgery
Education
University of Minnesota Medical School, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Beacon Medical Group IncGroup PAC ID 1254243306, 575 clinicians

Practice addresses (Care Compare)

500 Arcade Ave
Suite 230
Elkhart, IN 46514-2485
Phone (574) 522-6565

Hospital & facility affiliations

  • Elkhart General Hospital Hospital, Elkhart, IN, CCN 150018
  • Memorial Hospital of South Bend Hospital, South Bend, IN, CCN 150058
  • Goshen Hospital Hospital, Goshen, IN, CCN 150026

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary artery bypass graft (CABG)24
Pacemaker insertion or repair1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01039629INMDThoracic Surgery (Cardiothoracic Vascular Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Beacon Medical Group, Inc. CurrentSince Jan 1, 2014 Accepting new patients
Beacon Medical Group, Inc. Current Accepting new patients
Beacon Medical Group Inc CurrentSince Jan 1, 2014 Accepting new patients
Beacon Medical Group, Inc. Past Accepting new patients

Locations

500 Arcade Ave
Ste 230
Elkhart, IN 46514
Phone (574) 522-6565

600 East Blvd
Elkhart, IN 46514
Phone (574) 294-2621

6913 N Main St
Granger, IN 46530
Phone (574) 647-1500

3245 Health Dr
Ste 100
Granger, IN 46530
Phone (574) 647-2129

710 N Niles Ave
South Bend, IN 46617
Phone (574) 647-1610

707 N Michigan St
Ste 501
South Bend, IN 46601
Phone (574) 237-0644

Interoperability endpoints

  • Direct secure messaging: whalloran@mybeacon.cernerdirect.com
  • Direct secure messaging: halloran@mybeacon.cernerdirect.com

Organizations & group practices 4

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617062400000",
    "number": "1053486191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 N NILES AVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466171924",
            "telephone_number": "574-647-1610",
            "fax_number": "574-237-6069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 ARCADE AVE STE 230",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465142485",
            "telephone_number": "574-522-6565",
            "fax_number": "574-522-5572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALLORAN",
        "first_name": "WALTER",
        "middle_name": "HENRY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-22",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "IN",
            "license": "01039629",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100103250",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "HALLORAN@mybeacon.cernerdirect.com",
            "affiliation": "N",
            "address_1": "500 Arcade Ave Ste 230",
            "city": "Elkhart",
            "state": "IN",
            "country_code": "US",
            "postal_code": "465142485",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Elkhart, IN

Sources for this page

Verify at the official NPI Registry.