Active NPI
Andrew Kyle Watters, MD
- Emergency Medicine Physician
- Bloomington, IN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 01063914A
- Practice address
- 601 W 2ND St
Bloomington, IN 47403-2317 - Phone
- (812) 353-9515
- NPI assigned
- Mar 20, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 01063914A | IN | Primary |
Addresses
Primary practice location
601 W 2ND St
Bloomington, IN 47403-2317
Mailing address
PO Box 1329
Bloomington, IN 47402-1329
Phone (812) 353-2154
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200868430 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Emergency Medicine
- Education
- Indiana University School of Medicine, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1701 N Senate Blvd
Indianapolis, IN 46202-1239
Phone (888) 484-3258
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01063914A | IN | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Iu Health Medical Group, LLC | Current | Accepting new patients | |
| Indiana University Health Paoli Inc | Past | Accepting new patients |
Locations
2900 16th St
Bedford, IN 47421
Phone (812) 275-1200
601 W 2nd St
Bloomington, IN 47403
Phone (812) 353-5252
727 W 2nd St
Bloomington, IN 47403
Phone (812) 353-3450
1701 Senate Blvd
Indianapolis, IN 46202
Phone (317) 612-2754
2209 John R Wooden Dr
Martinsville, IN 46151
Phone (765) 342-3364
642 W Hospital Rd
Paoli, IN 47454
Phone (812) 723-2811
411 W Tipton St
Seymour, IN 47274
Phone (317) 888-3505
Organizations & group practices 3
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.
-
- General Practice Physician
- Indianapolis, IN
- NPI 1326893777
-
- Multi-Specialty Clinic/Center
- Bloomington, IN
- NPI 1013953983
-
- Emergency Medical Services (Emergency Medicine) Physician
- Paoli, IN
- NPI 1457519324
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Critical Access Hospital
- Bedford, IN
- NPI 1548260284
-
- General Acute Care Hospital
- Bloomington, IN
- NPI 1205860335
-
- General Acute Care Hospital
- Indianapolis, IN
- NPI 1144266024
-
- Critical Access Hospital
- Paoli, IN
- NPI 1912984451
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398988800000",
"number": "1396860979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1329",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474021329",
"telephone_number": "812-353-2154",
"fax_number": "812-353-5228"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "601 W 2ND ST",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474032317",
"telephone_number": "812-353-9515"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATTERS",
"first_name": "ANDREW",
"middle_name": "KYLE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-20",
"last_updated": "2014-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "IN",
"license": "01063914A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200868430",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2014; 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.