Bert Puckett Wall, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

048003 Issued in GA

Practice address

526 College Dr
Barnesville, GA 30204-1713

Phone

(770) 358-3284

Fax

(770) 358-1015

NPI assigned

Sep 3, 2006

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 2

Medicare fee-for-service enrollment

Enrolled in GA

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

Specialty

Family Practice

Education

Mercer University School of Medicine, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Peach Physician Services, PCGroup PAC ID 9234598855, 16 clinicians

Hightower Physician Services, PCGroup PAC ID 4486903176, 20 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Upson Regional Medical Center Hospital, Thomaston, GA, CCN 110002

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bert.wall@gadirect.net

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.

• Hightower Physician Services, PC

  • Hospitalist Physician
  • Thomaston, GA
  • NPI 1891296620
  Medicare reassignment Care Compare group NPD
• Peach Physician Services, PC

  • Hospitalist Physician
  • Byron, GA
  • NPI 1235821752
  Medicare reassignment Care Compare group
• Hospital Physician Services - Southeast Professional Corporation

  • Hospitalist Physician
  • Monroe, GA
  • NPI 1760410385
  Medicare reassignment NPD
• Upson Family Medical Center ,LLC

  • Family Medicine Physician
  • Thomaston, GA
  • NPI 1124528344
  Medicare reassignment NPD
• Barnesville Family Medicine, Inc

  • Family Medicine Physician
  • Barnesville, GA
  • NPI 1700918919
  NPD (past) Authorized official
• Upson County Hospital Inc

  • General Acute Care Hospital
  • Thomaston, GA
  • NPI 1659376630
  NPD

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

• Upson County Hospital Inc

  • General Acute Care Hospital
  • Thomaston, GA
  • NPI 1659376630
  Care Compare affiliation

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

{
    "created_epoch": "1157241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1154423754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "526 COLLEGE DR",
            "city": "BARNESVILLE",
            "state": "GA",
            "postal_code": "302041713",
            "telephone_number": "770-358-3284",
            "fax_number": "770-358-1015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "526 COLLEGE DR",
            "city": "BARNESVILLE",
            "state": "GA",
            "postal_code": "302041713",
            "telephone_number": "770-358-3284",
            "fax_number": "770-358-1015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "BERT",
        "middle_name": "PUCKETT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-03",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "048003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00841035G",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC / BS",
            "identifier": "52782413003",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David K.R. Thomson, M.D.
• Alice S Turner, RNC, WHNP
• Cynthia Ann Underwood, RN
• Upson Medical Associates, LLC
• Bianca Marina Veliz, RPH
• Caroline Jones Warren
• Kristie Keyon Watts, FNP
• Kamryn Carden Westbury
• Claire M Wheeler, PH.D.
• Amber Williams

• Family Medicine Physician in Barnesville, GA
• Providers in Barnesville, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.
• 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.