Walter R Eiseman, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

15233 Issued in KY

Practice address

1 Medical Village Dr
Edgewood, KY 41017-3403

Phone

(859) 301-2160

Fax

(859) 301-3932

NPI assigned

Nov 16, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1132099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375920000000",
    "number": "1063494169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 932163",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441930001",
            "telephone_number": "586-412-4000",
            "fax_number": "586-412-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL VILLAGE DR",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "410173403",
            "telephone_number": "859-301-2160",
            "fax_number": "859-301-3932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EISEMAN",
        "first_name": "WALTER",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-16",
        "last_updated": "2013-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "KY",
            "license": "15233",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMC",
            "identifier": "300013432",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2699263",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64152333",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Edgewood Dental Care PSC
• Edgewood Urgent Care
• Tammy Ricaforte Edlund, PA (ASCP)
• Jordan Egan, RBT
• Matthew Eilerman, APRN
• John P Eldridge, M.D.
• Alyssa Christine Elleman
• Paige Cecelia Elliott-Hunt, APRN
• Melodie Ellis, APRN
• Rachael Ellis

• Diagnostic Radiology Physician in Edgewood, KY
• Providers in Edgewood, KY by specialty
• Diagnostic Radiology Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.