Walter E Bantom III, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD04394E Issued in PA

Practice address

5615 W Girard Ave
Philadelphia, PA 19131-4128

Phone

(215) 477-5800

Fax

(215) 879-8447

NPI assigned

Jul 15, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal MedicineAlso: Addiction Medicine

Education

Temple University School of Medicine, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Penn Medicine Home Health Home health agency, Bala Cynwyd, PA, CCN 397125
• Mercy Catholic Medical Center- Mercy Fitzgerald Hospital, Darby, PA, CCN 390156
• Hospital of Univ of Pennsylvania Hospital, Philadelphia, PA, CCN 390111

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• West Phila Community Mental Health Consortium, Inc.

  • Counselor
  • Philadelphia, PA
  • NPI 1194757989
  Medicare reassignment
• West Phila Community Mental Health Consortium, Inc.

  • Adult Mental Health Clinic/Center
  • Philadelphia, PA
  • NPI 1841319332
  NPD

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

• Hospital of the University of PA

  • Ambulatory Fertility Facility
  • Phila, PA
  • NPI 1033262316

  Hospital

  Care Compare affiliation
• Presbyterian Medical Center of the University of Pennsylvania Health S

  • Home Health Agency
  • Bala Cynwyd, PA
  • NPI 1992746366
  Care Compare affiliation
• Trustees of the University of Pennsylvania

  • General Acute Care Hospital
  • Philadelphia, PA
  • NPI 1851370910
  Care Compare affiliation

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365552000000",
    "number": "1194741710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5615 W GIRARD AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191314128",
            "telephone_number": "215-477-5800",
            "fax_number": "215-879-8447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5615 W GIRARD AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191314128",
            "telephone_number": "215-477-5800",
            "fax_number": "215-879-8447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANTOM",
        "first_name": "WALTER",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-15",
        "last_updated": "2013-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD04394E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID - TYPE UNSPECIFIED",
            "identifier": "218045",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1172977",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENCE BLUE CROSS",
            "identifier": "0110990001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nikhil Deep Bansal, OD
• Pallavi Bansal, DMD
• Sanya Bansal, MD
• Sucheta Bansal
• Jeanamarie Banta, PT, DPT
• Jasmin Banton, DO
• Alicia Bao
• Kehan Bao
• Baptist Home of Philadelphia
• Justina W Baptiste, MD

• Internal Medicine Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Internal Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2013; 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.