Patrick Timothy Waters, D.O., F.A.A.F.P

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

License

0S003179L Issued in PA

Practice address

2101 W Lehigh Ave Ste a
Philadelphia, PA 19132-2664

Phone

(267) 866-7211

NPI assigned

Mar 28, 2006

Last updated

Mar 17, 2020By the provider in NPPES

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in PA

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

Family PracticeAlso: Geriatric Medicine

Education

Philadelphia College of Osteopathic Medicine, 1973

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Covenant House IncGroup PAC ID 3476591686, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: patrick.waters.p1@direct.covenanthousehealth.nextgenshare.com
• Direct secure messaging: patrick.waters@kohutiakandjamoliltd.chartmakerdirect.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Covenant House Inc

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
  • NPI 1659462679
  Medicare reassignment Care Compare group NPD
• Dedicated Pennsylvania Holding, LLC

  dba Dedicated Pennsylvania Mayfair

  • Specialist
  • Philadelphia, PA
  • NPI 1477053569
  Medicare reassignment NPD
• Covenant House Inc

  dba Tabor Kids Pediatric Mini Clinic

  • Pediatrics Physician
  • Philadelphia, PA
  • NPI 1669177911
  NPD
• Dedicated Pennsylvania Holding, LLC

  • Specialist
  • Philadelphia, PA
  • NPI 1841707965
  NPD
• Dedicated Pennsylvania Holding, LLC

  • Internal Medicine Physician
  • Philadelphia, PA
  • NPI 1942703137
  NPD
• Dedicated Pennsylvania Holding, LLC

  • Specialist
  • Philadelphia, PA
  • NPI 1366950776
  NPD (past)
• Nazareth Physician Services Inc

  • Family Medicine Physician
  • Philadelphia, PA
  • NPI 1265682082
  NPD (past)
• Nazareth Physician Services, Inc.

  • Ambulatory Surgical Clinic/Center
  • Philadelphia, PA
  • NPI 1275168718
  NPD (past)

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

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584403200000",
    "number": "1356302715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 NW 167TH ST",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "331695710",
            "telephone_number": "267-866-7211",
            "fax_number": "267-202-7398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 W LEHIGH AVE STE A",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191322664",
            "telephone_number": "267-866-7211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERS",
        "first_name": "PATRICK",
        "middle_name": "TIMOTHY",
        "name_prefix": "Dr.",
        "credential": "D.O., F.A.A.F.P",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-28",
        "last_updated": "2020-03-17",
        "certification_date": "2020-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "PA",
            "license": "0S003179L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO ONLY",
            "identifier": "85987",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE AND BLUE INDIV #",
            "identifier": "0058143000",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christal Waters-Porter
• Beverly Ann Waters, CRNP
• Ellen Kligerman Waters, CRNP
• Melinda Waters, CRNP
• Michael Waters
• Tiffany Waters
• Todd Bantom Waters, M.S. NCC
• Trinique Waters, RD, LDN
• Watershed and Ark of Salvation Ministries
• Shanley Waterson

• Geriatric Medicine (Family Medicine) Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Geriatric Medicine (Family Medicine) Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2020; 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.