Mark Waller, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

18067 Issued in OK

Practice address

1611 S Utica Ave
Ste 217
Tulsa, OK 74104-4909

Phone

(918) 744-3664

Fax

(918) 748-7688

NPI assigned

Apr 4, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OK

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

Anesthesiology

Education

University of Oklahoma College of Medicine, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Olympia Anesthesia PLCGroup PAC ID 5395767602, 13 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tulsa Spine & Specialty Hospital Hospital, Tulsa, OK, CCN 370216

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.

• Olympia Anesthesia, PLC

  • Anesthesiology Physician
  • Tulsa, OK
  • NPI 1205841186
  Medicare reassignment Care Compare group NPD

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

• Tulsa Spine & Specialty Hospital

  • General Acute Care Hospital
  • Tulsa, OK
  • NPI 1033185293
  Care Compare affiliation

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

{
    "created_epoch": "1144108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432771200000",
    "number": "1265494314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 S UTICA AVE",
            "address_2": "STE 217",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741044909",
            "telephone_number": "918-744-3664",
            "fax_number": "918-748-7688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 S UTICA AVE",
            "address_2": "STE 217",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741044909",
            "telephone_number": "918-744-3664",
            "fax_number": "918-748-7688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "MARK",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-04",
        "last_updated": "2015-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OK",
            "license": "18067",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00370953",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100031900A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Wallain, LPC
• Shelby Wallen, CRNA
• Danielle Justine Waller
• Garrett Williams Waller, MD
• Kelsey Nicole Waller, APRN - CNP
• Miles Coleman Waller, MD
• Wendy Michelle Waller
• Zoey E. Waller
• Sandra Lynn Walling
• Emily Erin Wallis, M.S.

• Anesthesiology Physician in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Anesthesiology Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2015; 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.