Nathan Frederick Walters, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

8066 Issued in KY

Practice address

2800 Cannons LN Ste 200
Louisville, KY 40205-2164

Phone

(502) 454-4885

Fax

(502) 452-1926

NPI assigned

Aug 18, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in KY

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

Specialty

Maxillofacial Surgery

Education

University of Texas Medical School at Houston, 2004

Medicare assignment

May accept Medicare assignment

Group practices

Kentuckiana Oral and Maxillofacial Surgery Assoc PSCGroup PAC ID 9638163454, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Kentuckiana Oral & Maxillofacial Surgery Assoc PSC

  • Oral and Maxillofacial Surgery (Dentist)
  • Louisville, KY
  • NPI 1396737011
  Medicare reassignment Care Compare group NPD Authorized official
• Dental Surgicenter of Louisville LLC

  • Anesthesiology Physician
  • Louisville, KY
  • NPI 1255846770
  NPD
• Dental Surgicenter of Louisville LLC

  • Ambulatory Surgical Clinic/Center
  • Louisville, KY
  • NPI 1487043386
  NPD

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

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541980800000",
    "number": "1265424907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 CANNONS LN STE 200",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402052164",
            "telephone_number": "502-454-4885",
            "fax_number": "502-452-1926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 CANNONS LN STE 200",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402052164",
            "telephone_number": "502-454-4885",
            "fax_number": "502-452-1926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "NATHAN",
        "middle_name": "FREDERICK",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-18",
        "last_updated": "2018-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "KY",
            "license": "8066",
            "primary": true
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "KY",
            "license": "8066",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200498320",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "000000339061",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60002789",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64082688",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brian Richard Walters, CRNA
• Brittany Walters
• Chadwick A Walters, DO
• Cristine Walters, MS, CCC-SLP
• Jennifer Walters, PA-C
• Anna Walton, LCSW
• Camille Juliet Walton
• Carol Walton, LCSW
• Charlee McKynna Walton
• Daymond Cortes Walton, LPCC

• Oral and Maxillofacial Surgery (Dentist) in Louisville, KY
• Providers in Louisville, KY by specialty
• Oral and Maxillofacial Surgery (Dentist) in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2018; 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.