Douglas Waters, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9106355 Issued in FL

Practice address

4311 Salisbury Rd
Jacksonville, FL 32216-6123

Phone

(904) 332-4300

Fax

(904) 332-4339

NPI assigned

Dec 6, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL, NC2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Merit-based Incentive Payment System (MIPS)

Final score

97.4 of 100Reported as group

Quality

99.47

Improvement activities

40

Cost

83.62

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Florida Emergency Physicians Kang and Associates MD LLC

  • Emergency Medical Services (Emergency Medicine) Physician
  • Orlando, FL
  • NPI 1811983752
  Medicare reassignment
• Raleigh Emergency Medicine Associates Inc

  • Emergency Medicine Physician
  • Raleigh, NC
  • NPI 1790736973
  Medicare reassignment
• Florida Em-I Medical Services, PA

  • Emergency Medicine Physician
  • Jacksonville, FL
  • NPI 1609296011

  Physician Assistant

  NPD (past)
• Kingsley Avenue Emergency Physicians LLC

  • Emergency Medicine Physician
  • Orange Park, FL
  • NPI 1679915300
  NPD (past)
• Kite Emergency Physicians LLC

  • Emergency Medicine Physician
  • Jacksonville, FL
  • NPI 1295155547
  NPD (past)

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

{
    "created_epoch": "1323129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323129600000",
    "number": "1326316308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4311 SALISBURY RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322166123",
            "telephone_number": "904-332-4300",
            "fax_number": "904-332-4339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4311 SALISBURY RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322166123",
            "telephone_number": "904-332-4300",
            "fax_number": "904-332-4339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERS",
        "first_name": "DOUGLAS",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-12-06",
        "last_updated": "2011-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9106355",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Annest Temirra Waters, ESTHETICIAN
• Baylee Waters
• Bria Waters, CLINICAL COUNSELOR
• Courtney Waters
• Deanna L Waters, LMT
• Edward William Waters
• John Marshall Waters, APRN
• Katie Knight Waters, PA-C
• Latoria Waters
• Michael Waters

• Physician Assistant in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2011; 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.