NPIMap

Individual provider Active NPI

Mary Melanie Waller, MD

  • Urology Physician
  • Olney, IL
National Provider Identifier
1225024615
Registry record updated Oct 5, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
036119328 Issued in IL
Practice address
1200 N East St
Olney, IL 62450-2432
Phone
(618) 395-5222
NPI assigned
Sep 21, 2005
Last updated
Oct 5, 2009By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 036119328 IL Primary

Addresses

Primary practice location

1200 N East St
Olney, IL 62450-2432

Mailing address

PO Box 97
Olney, IL 62450-0097
Phone (618) 395-7340

Other names 1

  • Ms. Mary Melanie Haluszka Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080315000039 IL Practitioner - Urology 4789665928 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Uniformed Services Uhs Fe Hebert School of Med, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Richland Memorial Hospital IncGroup PAC ID 3870565732, 107 clinicians

Practice addresses (Care Compare)

800 E Locust St
Olney, IL 62450-2553
Phone (618) 395-7340

900 E Scott St
Olney, IL 62450-2576
Phone (618) 395-1000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036119328ILMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carle Health Medical Group CurrentSince Nov 1, 2020 Accepting new patients
Richland Memorial Hospital, Inc Current Accepting new patients
Richland Memorial Hospital, Inc Urology CurrentSince Aug 10, 2009 Accepting new patients
Richland Memorial Hospital, Inc Past Accepting new patients
Medical Clinic of North Texas PLLC Past Accepting new patients
Urology Associates of North Texas LLP Urology Past Accepting new patients

Locations

1200 N East St
Olney, IL 62450
Phone (618) 392-2940

800 E Locust St
Olney, IL 62450
Phone (618) 395-2131

900 E Scott St
Olney, IL 62450
Phone (618) 345-1000

1201 Ricker Rd
Salem, IL 62881
Phone (618) 548-3194

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1127260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254700800000",
    "number": "1225024615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 97",
            "city": "OLNEY",
            "state": "IL",
            "postal_code": "624500097",
            "telephone_number": "618-395-7340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 N EAST ST",
            "city": "OLNEY",
            "state": "IL",
            "postal_code": "624502432",
            "telephone_number": "618-395-5222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "MARY",
        "middle_name": "MELANIE",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-21",
        "last_updated": "2009-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IL",
            "license": "036119328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "HALUSZKA",
            "middle_name": "MELANIE",
            "prefix": "MS.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Olney, IL

Sources for this page

Verify at the official NPI Registry.