Active NPI
Laura Ingram Walpole, DO
- Family Medicine Physician
- Peoria, AZ
National Provider Identifier
1245528165
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 968
- Practice address
- 9749 W Tonopah Dr
Peoria, AZ 85382-5110 - Phone
- (623) 693-0476
- NPI assigned
- Jul 12, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 968 | NE | Primary |
Addresses
Primary practice location
9749 W Tonopah Dr
Peoria, AZ 85382-5110
Mailing address
9749 W Tonopah Dr
Peoria, AZ 85382-5110
Phone (623) 693-0476
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NE
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201201002198 | NE | Order and Referring Only - Family Practice | 2365694064 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 968 | NE | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1310428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1477526400000",
"number": "1245528165",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9749 W TONOPAH DR",
"city": "PEORIA",
"state": "AZ",
"postal_code": "853825110",
"telephone_number": "623-693-0476"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9749 W TONOPAH DR",
"city": "PEORIA",
"state": "AZ",
"postal_code": "853825110",
"telephone_number": "623-693-0476"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALPOLE",
"first_name": "LAURA",
"middle_name": "INGRAM",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-07-12",
"last_updated": "2016-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NE",
"license": "968",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2016; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.