Individual provider Active NPI

Rebecca Walter, NP

  • Nurse Practitioner
  • Saint Joseph, MI
National Provider Identifier
1174833560
Registry record updated Oct 19, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704152349 Issued in MI
Practice address
183 Peace Blvd
Saint Joseph, MI 49085-9146
Phone
(269) 428-3500
Fax
(269) 429-6429
NPI assigned
Oct 19, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4704152349 MI Primary

Addresses

Primary practice location

183 Peace Blvd
Saint Joseph, MI 49085-9146

Mailing address

183 Peace Blvd
Saint Joseph, MI 49085-9146
Phone (269) 428-3500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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

Enrollment IDStateProvider typePAC IDDetails
I20120503000643 MI Practitioner - Nurse Practitioner 7416119664 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

183 Peace Blvd
Saint Joseph, MI 49085-9146
Phone (269) 428-3500

Hospital & facility affiliations

  • Lakeland Hospital, St Joseph Hospital, St Joseph, MI, CCN 230021

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704152349MIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Michigan Center for Orthopaedic and Sports Medicine P CurrentSince Feb 15, 2007 Accepting new patients

Locations

183 Peace Blvd
Saint Joseph, MI 49085
Phone (269) 408-1636

Organizations & group practices 1

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 1

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": "1287446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287446400000",
    "number": "1174833560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "183 PEACE BLVD",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490859146",
            "telephone_number": "269-428-3500",
            "fax_number": "269-429-6429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "183 PEACE BLVD",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490859146",
            "telephone_number": "269-428-3500",
            "fax_number": "269-429-6429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTER",
        "first_name": "REBECCA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-19",
        "last_updated": "2010-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704152349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Joseph, MI

Sources for this page

Verify at the official NPI Registry.