NPIMap

Individual provider Active NPI

Theodore Waller, M.D.

  • Clinical Cardiac Electrophysiology Physician
  • Cincinnati, OH
National Provider Identifier
1386609881
Registry record updated Oct 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X
License
35046812 Issued in OH
Practice address
11140 Montgomery Rd
Cincinnati, OH 45249-2309
Phone
(513) 792-7800
Fax
(513) 792-7807
NPI assigned
Apr 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 35046812 OH
Clinical Cardiac Electrophysiology Physician 207RC0001X 35046812 OH Primary

Addresses

Primary practice location

11140 Montgomery Rd
Cincinnati, OH 45249-2309

Mailing address

237 William Howard Taft Rd
2ND Floor, Cbo 2-3
Cincinnati, OH 45219-2610
Phone (513) 792-7800

Other identifiers 7

IdentifierTypeStateIssuer
000000238182OtherANTHEM MIDDLETOWN
64860562MedicaidKY
0549464MedicaidOH
2520401OtherUNITED
0642403OtherAETNA
100335970MedicaidIN
000000019745OtherANTHEM

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address twaller7030@direct.thechristhospital.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041020001280 OH Practitioner - Cardiac ElectrophysiologyPractitioner - Cardiovascular Disease (Cardiology)Practitioner - Other (Physician) 6901795798 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiac ElectrophysiologyAlso: Cardiovascular Disease (Cardiology)
Education
University of Cincinnati College of Medicine, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Christ Hospital Cardiovascular Associates LLCGroup PAC ID 1658449715, 151 clinicians

Practice addresses (Care Compare)

2139 Auburn Ave
Cincinnati, OH 45219-2906
Phone (513) 585-2000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.59 of 100Reported as group
Quality
77.64
Promoting interoperability
100
Improvement activities
40
Cost
77.68

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Ohio Heart and Vascular Center, Inc Cardiovascular Disease Past Accepting new patients
Diagnostic Cardiologists Inc. Cardiovascular Disease Past Accepting new patients
Christ Hospital Cardiology Assoc Cardiovascular Disease Past Accepting new patients
Ohvc Associates, LLC Cardiovascular Disease Past Accepting new patients
Neurological & Sleep Disorders Inc Past Accepting new patients

Organizations & group practices 6

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": "1145318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603411200000",
    "number": "1386609881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "237 WILLIAM HOWARD TAFT RD",
            "address_2": "2ND FLOOR, CBO 2-3",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452192610",
            "telephone_number": "513-792-7800",
            "fax_number": "513-792-7807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11140 MONTGOMERY RD",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452492309",
            "telephone_number": "513-792-7800",
            "fax_number": "513-792-7807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "THEODORE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-18",
        "last_updated": "2020-10-23",
        "certification_date": "2020-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "OH",
            "license": "35046812",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "OH",
            "license": "35046812",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM MIDDLETOWN",
            "identifier": "000000238182",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64860562",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0549464",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED",
            "identifier": "2520401",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0642403",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100335970",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000019745",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "twaller7030@direct.thechristhospital.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "11140 Montgomery Rd",
            "city": "Cincinnati",
            "state": "OH",
            "country_code": "US",
            "postal_code": "452492309",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

Verify at the official NPI Registry.