Walter J Revell Jr., MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

11191 Issued in SC

Practice address

305 W 1St St
Vidalia, GA 30474-3302

Phone

(912) 538-9080

Fax

(912) 538-9085

NPI assigned

Aug 25, 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 1

Medicare fee-for-service enrollment

Enrolled in GA

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

General Surgery

Education

Medical College of Georgia School of Medicine, 1974

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Peterson Dermatology, P.C.Group PAC ID 7113018334, 4 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

77.65 of 100Reported as group

Quality

55.3

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

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

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.

• Peterson Dermatology, P.C.

  • Dermatology Physician
  • Vidalia, GA
  • NPI 1932300886
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525132800000",
    "number": "1275641995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 W 1ST ST",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304743302",
            "telephone_number": "912-538-9080",
            "fax_number": "912-538-9085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 W 1ST ST",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304743302",
            "telephone_number": "912-538-9080",
            "fax_number": "912-538-9085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVELL",
        "first_name": "WALTER",
        "middle_name": "J",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2018-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "SC",
            "license": "11191",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111916",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sreekanth Reddy, MD
• Madison Jazman Reese, LPN
• Restore Metabolix of Vidalia
• Restore Wellness and Aesthetics
• Heidi Marie Reuschling, DC
• Jennifer Richter, LCSW
• Amanda Dawn Rizzo, M. ED. , BCBA
• Robert B Clark Jr MD LLC
• Robert S Riddick MDPC
• Michael David Robinson, MD

• Surgery Physician in Vidalia, GA
• Providers in Vidalia, GA by specialty
• Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 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.