Active NPI
Daniel Mark Waller, MD
- Anesthesiology Physician
- Des Moines, IA
National Provider Identifier
1174503528
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 28024
- Practice address
- 411 Laurel St
Ste 3170
Des Moines, IA 50314 - Phone
- (515) 283-0463
- NPI assigned
- Jan 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 28024 | IA | Primary |
Addresses
Primary practice location
411 Laurel St
Ste 3170
Des Moines, IA 50314
Mailing address
411 Laurel St
Ste 3170
Des Moines, IA 50314
Phone (515) 283-0463
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0073957 | Medicaid | IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28024 | IA | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192752000000",
"number": "1174503528",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "411 LAUREL ST",
"address_2": "STE 3170",
"city": "DES MOINES",
"state": "IA",
"postal_code": "50314",
"telephone_number": "515-283-0463"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "411 LAUREL ST",
"address_2": "STE 3170",
"city": "DES MOINES",
"state": "IA",
"postal_code": "50314",
"telephone_number": "515-283-0463"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLER",
"first_name": "DANIEL",
"middle_name": "MARK",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-20",
"last_updated": "2007-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "IA",
"license": "28024",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0073957",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Des Moines, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.