Angelique Gloster Waller, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

35-067334 Issued in OH

Practice address

8250 Kenwood Crossing Way
#205
Cincinnati, OH 45236

Phone

(513) 948-8444

Fax

(513) 948-0756

NPI assigned

Oct 3, 2006

Sex

Female

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 OH

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/FmRItZc30RH60LjxwsIxQM4HGo6XcQXK/
• 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.

• CHMC Community Health Services Network

  • Pediatrics Physician
  • Cincinnati, OH
  • NPI 1023637774
  Medicare reassignment NPD
• CHMC Community Health Services Network

  • Pediatrics Physician
  • Cincinnati, OH
  • NPI 1245821271
  NPD
• CHMC Community Health Services Network

  • Pediatrics Physician
  • Batesville, IN
  • NPI 1053464305
  NPD (past)

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729036800000",
    "number": "1306931738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12061 SHERATON LN",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452461611",
            "telephone_number": "513-336-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8250 KENWOOD CROSSING WAY",
            "address_2": "#205",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "45236",
            "telephone_number": "513-948-8444",
            "fax_number": "513-948-0756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "ANGELIQUE",
        "middle_name": "GLOSTER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-03",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35-067334",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0108387",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Yvonne Sue Wallace, LPN
• Elizabeth Wallbrown
• Taylor Elaine Wallen, MD
• Allison Wallenhorst, APRN, BC-WHNP
• Angelica Waller
• Celeste M Waller, PSY D
• Da'Vonna Waller
• Don'NA C Waller
• Lester Waller
• Maria I Waller, CCDC 1

• Pediatrics Physician in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Pediatrics Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2024; 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.

Verify at the official NPI Registry.