Brent Steven Waller, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95013038 Issued in CA

Practice address

3400 W Ball Rd Ste 207
Anaheim, CA 92804-3737

Phone

(714) 683-5100

NPI assigned

Feb 6, 2020

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 1

Medicare fee-for-service enrollment

Enrolled in CA

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Anooshiravan Hami, M.D., Corp

  • Pulmonary Disease Physician
  • Anaheim, CA
  • NPI 1710382189
  Medicare reassignment

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

{
    "created_epoch": "1580947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581033600000",
    "number": "1356973432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "766 S LANGTREE LN",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928074897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 W BALL RD STE 207",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928043737",
            "telephone_number": "714-683-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "BRENT",
        "middle_name": "STEVEN",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-02-06",
        "last_updated": "2020-02-07",
        "certification_date": "2020-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95013038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA BRN",
            "identifier": "95013038",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan Walker, MD
• Patricia Wall, BHT
• Lindsay Michelle Wallace, RAS
• Tylor Wallace
• Breanna Waller, SLPA
• Dillon Waller
• Walmart Inc.
• Walmart Inc.
• Walmart Inc.
• Walmart Inc.

• Family Nurse Practitioner in Anaheim, CA
• Providers in Anaheim, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.