Individual provider Active NPI

Thomas M Walters, CRNA

  • Certified Registered Nurse Anesthetist
  • Hattiesburg, MS
National Provider Identifier
1336160050
Registry record updated Jan 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R717886 Issued in MS
Practice address
415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone
(601) 261-3606
Fax
(601) 579-5166
NPI assigned
Jul 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X R717886 MS Primary

Addresses

Primary practice location

415 S 28TH Ave
Hattiesburg, MS 39401-7246

Mailing address

15 Avery KNLS
Hattiesburg, MS 39402-8131
Phone (601) 297-6283

Other identifiers 2

IdentifierTypeStateIssuer
1501859MedicaidLA
00114837MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, AL, FL3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20040402000543 MS Practitioner - Certified Registered Nurse Anesthetist (Crna) 6002808573 Reassigns benefits to 3 organizations
I20240507003103 AL Practitioner - Certified Registered Nurse Anesthetist (Crna) 6002808573 Reassigns benefits to 1 organization
I20250930004561 FL Practitioner - Certified Registered Nurse Anesthetist (Crna) 6002808573 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ams Baptist LLCGroup PAC ID 6901099688, 80 clinicians
Hattiesburg Clinic PAGroup PAC ID 5193706794, 525 clinicians

Practice addresses (Care Compare)

123 Baptist Way
Pensacola, FL 32503-2254
Phone (448) 227-8478

415 S 28TH Ave
Hattiesburg, MS 39401-7246

415 S 28TH Ave 3Rd Floor
Ambulatory Cardiovascular Center of Mississ
Hattiesburg, MS 39401-7246
Phone (601) 268-1734

415 S 28TH Ave FL
Hattiesburg, MS 39401-7246
Phone (601) 264-6000

6051 U S Hwy 49
Forrest General Hospital
Hattiesburg, MS 39401-7200
Phone (601) 264-6000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Perioperative Services of Mississippi, LLC CurrentSince Jan 16, 2023 Accepting new patients
Hattiesburg Clinic PA CurrentSince Mar 15, 2004 Accepting new patients
Ams of Gulf Breeze LLC Nurse Anesthetist, Certified Registered CurrentSince Aug 18, 2025 Accepting new patients
USA Health Anesthesia Billing Services, LLC Nurse Anesthetist, Certified Registered CurrentSince Apr 1, 2024 Accepting new patients
Hattiesburg Clinic, PA CurrentSince Mar 15, 2004 Accepting new patients
Ams Baptist LLC Nurse Anesthetist, Certified Registered CurrentSince Aug 18, 2025 Accepting new patients
Lifelinc Anesthesia, PLLC Nurse Anesthetist, Certified Registered CurrentSince Mar 1, 2021 Accepting new patients

Locations

1700 Center St
Mobile, AL 36604
Phone (251) 415-1000

2451 Fillingim St
Mobile, AL 36617
Phone (251) 434-3711

123 Baptist Way
Pensacola, FL 32503
Phone (850) 434-4011

1110 Gulf Breeze Pkwy
Pensacola Beach, FL 32561
Phone (850) 438-1848

350 Crossgates Blvd
Brandon, MS 39042
Phone (601) 824-8500

634 Leigh Dr
Columbus, MS 39705
Phone (601) 978-3393

415 S 28th Ave
Hattiesburg, MS 39401
Phone (601) 261-3606

1225 N State St
Jackson, MS 39202
Phone (601) 292-4261

1710 W 12th St
Laurel, MS 39440
Phone (601) 369-2021

Organizations & group practices 7

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706140800000",
    "number": "1336160050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 AVERY KNLS",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394028131",
            "telephone_number": "601-297-6283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017246",
            "telephone_number": "601-261-3606",
            "fax_number": "601-579-5166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "THOMAS",
        "middle_name": "M",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-21",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MS",
            "license": "R717886",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1501859",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00114837",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.