Nicholas Ryan Walters, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085.004177 Issued in IL

Practice address

7600 W College Dr
Palos Heights, IL 60463-1001

Phone

(708) 361-0600

NPI assigned

Apr 13, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: nicholas.walters.p1@direct.parkviewortho.nextgenshare.com

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.

• Emergency Medical Associates of Palos, LTD.

  • Emergency Medicine Physician
  • Palos Heights, IL
  • NPI 1285918128
  Medicare reassignment
• Midwest Emergency Northern Illinois Inc

  • Emergency Medicine Physician
  • Ottawa, IL
  • NPI 1427217504
  NPD (past)

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

{
    "created_epoch": "1144886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424390400000",
    "number": "1144284449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 W ELLE ST",
            "city": "ROMEOVILLE",
            "state": "IL",
            "postal_code": "604465295",
            "telephone_number": "630-723-8699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7600 W COLLEGE DR",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604631001",
            "telephone_number": "708-361-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "NICHOLAS",
        "middle_name": "RYAN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-13",
        "last_updated": "2015-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": "096-002105",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.004177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walid Habbal DDS PC
• Tenille Tenille Wallace-Bell, LPC
• Gabriel Abraham Wallace, MD
• Joseph Wallace, DPT
• Katherine M Walter, PA-C
• Payton Ward
• Steven R Wardell, M.D.
• Michael Watson
• Katherine Wax, PT
• WCS Occupational Rehabilitation and Sports Medicine, Inc.

• Physician Assistant in Palos Heights, IL
• Providers in Palos Heights, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.