Individual provider Active NPI

Walter Eric Loch, MD

  • Otolaryngology Physician
  • Bradenton, FL
National Provider Identifier
1407815582
Registry record updated Aug 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
ME102204 Issued in FL
Practice address
701 Manatee Ave W
Suite 202
Bradenton, FL 34205-8604
Phone
(941) 748-2455
Fax
(941) 750-9704
NPI assigned
Mar 20, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 16, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X ME102204 FL Primary

Addresses

Primary practice location

701 Manatee Ave W
Suite 202
Bradenton, FL 34205-8604

Mailing address

701 Manatee Ave W
Suite 202
Bradenton, FL 34205-8604
Phone (941) 748-2455

Other identifiers 2

IdentifierTypeStateIssuer
1962739334OtherFLFL MEDICARE
52026OtherFLBCBS FLORIDA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20080808000664 FL Practitioner - Otolaryngology 1456370253 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME102204FLMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Charles C Greene MD PHD PA Otolaryngology CurrentSince Dec 20, 2018 Accepting new patients
Ear, Nose, and Throat Associates of Manatee, PA CurrentSince Feb 14, 2016 Accepting new patients
Charles C Greene MD PHD PA Otolaryngology CurrentSince Dec 20, 2018 Accepting new patients
Alderman & Lumpkin Et Al Otolaryngology Past Accepting new patients

Locations

701 Manatee Ave W
Ste 202
Bradenton, FL 34205
Phone (941) 748-2455

11512 Lake Mead Ave
Unit 536
Jacksonville, FL 32256
Phone (904) 222-6103

11512 Lake Mead Ave
Unit 531
Jacksonville, FL 32256
Phone (904) 419-2054

789 W Duval St
Lake City, FL 32055
Phone (386) 755-1546

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1142812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471305600000",
    "number": "1407815582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 MANATEE AVE W",
            "address_2": "SUITE 202",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342058604",
            "telephone_number": "941-748-2455",
            "fax_number": "941-750-9704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 MANATEE AVE W",
            "address_2": "SUITE 202",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342058604",
            "telephone_number": "941-748-2455",
            "fax_number": "941-750-9704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOCH",
        "first_name": "WALTER",
        "middle_name": "ERIC",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-20",
        "last_updated": "2016-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "FL",
            "license": "ME102204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL MEDICARE",
            "identifier": "1962739334",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FLORIDA",
            "identifier": "52026",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bradenton, FL

Sources for this page

Verify at the official NPI Registry.