Individual provider Active NPI

Nicholas Walter, M.D.

  • Family Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1235493222
Registry record updated Jun 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
R73521 Issued in AZ
Practice address
2927 N 7TH Ave
Peppertree Building - Window #3
Phoenix, AZ 85013-4102
Phone
(602) 406-3153
Fax
(602) 406-7176
NPI assigned
Jun 25, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 25, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X R73521 AZ Primary

Addresses

Primary practice location

2927 N 7TH Ave
Peppertree Building - Window #3
Phoenix, AZ 85013-4102

Mailing address

2927 N 7TH Ave
Peppertree Building - Window #3
Phoenix, AZ 85013-4102
Phone (602) 406-3153

Other identifiers 1

IdentifierTypeStateIssuer
R73521OtherCATRAINING PERMIT

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240809002344 TX Practitioner - Family Practice 9436448099

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R73521AZMDFamily Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1340582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340582400000",
    "number": "1235493222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2927 N 7TH AVE",
            "address_2": "PEPPERTREE BUILDING - WINDOW #3",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850134102",
            "telephone_number": "602-406-3153",
            "fax_number": "602-406-7176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2927 N 7TH AVE",
            "address_2": "PEPPERTREE BUILDING - WINDOW #3",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850134102",
            "telephone_number": "602-406-3153",
            "fax_number": "602-406-7176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTER",
        "first_name": "NICHOLAS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-25",
        "last_updated": "2012-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "R73521",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRAINING PERMIT",
            "identifier": "R73521",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.