NPIMap

Individual provider Active NPI

Jeffrey Glen Walls, M.D.

  • Critical Care Medicine (Internal Medicine) Physician
  • Charlotte, NC
National Provider Identifier
1114987807
Registry record updated Feb 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X
License
200300423 Issued in NC
Practice address
1918 Randolph Rd Ste 580
Charlotte, NC 28207-1116
Phone
(704) 384-9900
Fax
(704) 384-9919
NPI assigned
Mar 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 200300423 NC
Pulmonary Disease Physician 207RP1001X 200300423 NC
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 200300423 NC Primary

Addresses

Primary practice location

1918 Randolph Rd Ste 580
Charlotte, NC 28207-1116

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 384-9900

Other identifiers 2

IdentifierTypeStateIssuer
N0042BMedicaidSC
89134K9MedicaidNC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jwalls15010@direct.novanthealth.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100327000427 NC Practitioner - Pulmonary Disease 7810023975 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary Disease
Education
University of Chicago, Pritzker School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, shared by 14 NPIs, 2,413 clinicians

Practice addresses (Care Compare)

14215 Ballantyne Corporate PL
Suite 240
Charlotte, NC 28277-3875
Phone (704) 316-5000

1900 Randolph Rd
Suite 300
Charlotte, NC 28207-1106
Phone (704) 384-6225

Hospital & facility affiliations

  • Novant Health Presbyterian Medical Center Hospital, Charlotte, NC, CCN 340053
  • Novant Health Matthews Medical Center Hospital, Matthews, NC, CCN 340171
  • Novant Health Ballantyne Medical Center Hospital, Charlotte, NC, CCN 340195
  • Novant Health Mint Hill Medical Center Hospital, Charlotte, NC, CCN 340190
  • Novant Health Huntersville Medical Center Hospital, Huntersville, NC, CCN 340183

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
200300423NCMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC CurrentSince Jul 1, 2003 Accepting new patients
Novant Medical Group, Inc Pulmonary Disease CurrentSince Feb 8, 2017 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Medical Group Inc Critical Care Medicine CurrentSince Jul 1, 2003 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients
Novant Health Medical Group, LLC Internal Medicine Past Accepting new patients

Locations

14215 Ballantyne Corporate Pl
Ste 240
Charlotte, NC 28277

1900 Randolph Rd
Ste 300
Charlotte, NC 28207
Phone (704) 316-3820

201 Queens Rd
Charlotte, NC 28204
Phone (704) 316-5285

1918 Randolph Rd
Ste 580
Charlotte, NC 28207
Phone (704) 333-9113

11840 Southmore Dr
Ste 201
Charlotte, NC 28277
Phone (704) 316-9001

10030 Gilead Rd
Ste 300
Huntersville, NC 28078
Phone (704) 384-7972

1450 Matthews Township Pkwy
Ste 380
Matthews, NC 28105
Phone (704) 264-3500

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

190 Kimel Park Dr
Ste 120
Winston Salem, NC 27103
Phone (336) 277-2200

3333 Silas Creek Pkwy
Winston Salem, NC 27103
Phone (336) 277-8800

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

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 8

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": "1143244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676851200000",
    "number": "1114987807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "704-384-9900",
            "fax_number": "704-384-9919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1918 RANDOLPH RD STE 580",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071116",
            "telephone_number": "704-384-9900",
            "fax_number": "704-384-9919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLS",
        "first_name": "JEFFREY",
        "middle_name": "GLEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-25",
        "last_updated": "2023-02-20",
        "certification_date": "2023-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "200300423",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NC",
            "license": "200300423",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "NC",
            "license": "200300423",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N0042B",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89134K9",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jwalls15010@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "1900 Randolph Rd",
            "address_2": "Suite 580",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282071122",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.