Active NPI
Todd J Waltrip, MD
- Surgery Physician
- Milwaukee, WI
National Provider Identifier
1174553432
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 66443
- Practice address
- 2801 W Kinnickinnic River Pkwy
Milwaukee, WI 53215-3669 - Phone
- (414) 649-3240
- NPI assigned
- Jul 3, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | K9452 | TX | |
| Surgery Physician | 208600000X | 66443 | WI | Primary |
Addresses
Primary practice location
2801 W Kinnickinnic River Pkwy
Milwaukee, WI 53215-3669
Mailing address
2801 W Kinnickinnic River Pkwy
Milwaukee, WI 53215-3669
Phone (414) 649-3240
Other practice location 1
703 E Marshall Ave
Suite 3000
Longview, TX 75601-5500
Phone (903) 315-2762
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 |
|---|---|---|---|
| K9452 | TX | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Longview Specialty Physicians | Past | Accepting new patients | |
| Diagnostic Clinic of Longview PA | Surgery | Past | Accepting new patients |
Interoperability endpoints
- https://api.platform.athenahealth.com/23550/brand/1/csg/1/fhir/r4
Organizations & group practices 2
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.
-
- Durable Medical Equipment & Medical Supplies
- Longview, TX
- NPI 1306063490
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1174553432",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2801 W KINNICKINNIC RIVER PKWY",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532153669",
"telephone_number": "414-649-3240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2801 W KINNICKINNIC RIVER PKWY",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532153669",
"telephone_number": "414-649-3240"
}
],
"practiceLocations": [
{
"address_1": "703 E Marshall Ave",
"address_2": "Suite 3000",
"address_purpose": "LOCATION",
"city": "Longview",
"state": "TX",
"postal_code": "756015500",
"country_code": "US",
"telephone_number": "903-315-2762",
"fax_number": "903-315-2595",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WALTRIP",
"first_name": "TODD",
"middle_name": "J",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-03",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "TX",
"license": "K9452",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "WI",
"license": "66443",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.