Individual provider Active NPI

Scott Evans Walker, CRNA

  • Certified Registered Nurse Anesthetist
  • Hattiesburg, MS
National Provider Identifier
1104840834
Registry record updated Aug 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R8262833 Issued in MS
Practice address
415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone
(601) 261-3606
Fax
(601) 579-5166
NPI assigned
Jul 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X R8262833 MS Primary

Addresses

Primary practice location

415 S 28TH Ave
Hattiesburg, MS 39401-7246

Mailing address

415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 261-3606

Other identifiers 2

IdentifierTypeStateIssuer
02073724MedicaidMS
640507572XXOtherMSAMERICAN ADMIN GROUP

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address swalker4134@directpatientrecord.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, LA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20041116000476 MS Practitioner - Certified Registered Nurse Anesthetist (Crna) 0749244150 Reassigns benefits to 2 organizations
I20250709004353 LA Practitioner - Certified Registered Nurse Anesthetist (Crna) 0749244150 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Health Shreveport, LLCGroup PAC ID 7416207196, 64 clinicians
North Mississippi Medical Center, Inc.Group PAC ID 9931010600, 361 clinicians

Practice addresses (Care Compare)

1541 Kings Hwy
Shreveport, LA 71103-4228
Phone (318) 626-0000

830 S Gloster
North Ms Med Ctr Sleep Lab
Tupelo, MS 38801-4934
Phone (662) 377-3258

830 S Gloster St
Tupelo, MS 38801-4934

830 S Gloster St 3Rd FL E Tower
Tupelo, MS 38801-4934

Hospital & facility affiliations

  • Ochsner Lsu Health Shreveport Hospital, Shreveport, LA, CCN 190098
  • North Mississippi Medical Center Hospital, Tupelo, MS, CCN 250004

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R8262833MSMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Hattiesburg Clinic PA CurrentSince Sep 1, 2004 Accepting new patients
University Health Shreveport LLC CurrentSince Jul 1, 2025 Accepting new patients
North Mississippi Medical Center CurrentSince Aug 1, 2025 Accepting new patients
North Mississippi Medcial Center, Inc. CurrentSince Aug 1, 2025 Accepting new patients
University Health Shreveport LLC Nurse Anesthetist, Certified Registered CurrentSince Jul 1, 2025 Accepting new patients
North Mississippi Medical Center Inc Current Accepting new patients
Hattiesburg Clinic, PA CurrentSince Sep 1, 2004 Accepting new patients

Locations

911 Margaret Pl
Shreveport, LA 71101
Phone (318) 626-4200

1541 Kings Hwy
Shreveport, LA 71103
Phone (318) 626-0287

415 S 28th Ave
Hattiesburg, MS 39401
Phone (601) 261-3606

830 S Gloster St
Tupelo, MS 38801
Phone (662) 377-3136

Organizations & group practices 7

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 2

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": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597017600000",
    "number": "1104840834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017246",
            "telephone_number": "601-261-3606",
            "fax_number": "601-579-5240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017246",
            "telephone_number": "601-261-3606",
            "fax_number": "601-579-5166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALKER",
        "first_name": "SCOTT",
        "middle_name": "EVANS",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2020-08-10",
        "certification_date": "2020-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MS",
            "license": "R8262833",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02073724",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN ADMIN GROUP",
            "identifier": "640507572XX",
            "state": "MS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "swalker4134@directpatientrecord.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "415 S 28th Ave",
            "city": "Hattiesburg",
            "state": "MS",
            "country_code": "US",
            "postal_code": "394017246",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.