NPIMap

Individual provider Active NPI

Jonathan E Walters, M.D.

  • Family Medicine Physician
  • Metropolis, IL
National Provider Identifier
1427286038
Registry record updated May 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036144530 Issued in IL
Practice address
28 Chick St Ste 100
Metropolis, IL 62960-2467
Phone
(618) 638-1343
Fax
(618) 638-1340
NPI assigned
Jun 23, 2009
Last updated
May 10, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 45065 KY
Family Medicine Physician 207Q00000X 036144530 IL Primary

Addresses

Primary practice location

28 Chick St Ste 100
Metropolis, IL 62960-2467

Mailing address

28 Chick St
Metropolis, IL 62960-2467
Phone (618) 524-2176

Other practice location 1

28 Chick St
Metropolis, IL 62960-2467
Phone (618) 524-2176 ext. 2382

Other practice location 2

1204 W 10th St
Metropolis, IL 62960-2433
Phone (618) 524-3572

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20180320001884 IL Practitioner - Family Practice 7911142831 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Louisville School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Massac Memorial HospitalGroup PAC ID 3072422799, 15 clinicians

Practice addresses (Care Compare)

1204 W 10TH St
Suite Aandb
Metropolis, IL 62960-2480
Phone (618) 524-3572

28 Chick St
Metropolis, IL 62960-2467
Phone (618) 524-2176

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036144530ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Massac Memorial Hospital CurrentSince Feb 1, 2018 Accepting new patients
The Ophthalmology Group, LLC CurrentSince Aug 1, 2016 Accepting new patients
Massac Memorial Hospital CurrentSince Feb 1, 2018 Accepting new patients
Massac Memorial Hospital Current Accepting new patients
Four Rivers Internal Medicine, PLLC CurrentSince Jan 7, 2013 Accepting new patients
Massac Memorial Hospital Past Accepting new patients
Baptist Healthcare System Inc PastSince Jan 7, 2013 Accepting new patients
Massac Memorial Hospital Past Accepting new patients

Locations

1204 W 10th St
Ste A
Metropolis, IL 62960
Phone (618) 524-3572

1204 W 10th St
Ste C
Metropolis, IL 62960
Phone (618) 524-2182

28 Chick St
Metropolis, IL 62960
Phone (618) 427-2680

28 Chick St
Ste 100
Metropolis, IL 62960
Phone (618) 524-8381

3131 Parisa Dr
Paducah, KY 42003
Phone (270) 444-8000

4630 Village Square Dr
Paducah, KY 42001
Phone (270) 442-1671

4630 Village Square Dr
Ste 102
Paducah, KY 42001
Phone (270) 443-4393

Interoperability endpoints

  • Direct secure messaging: jonathanwalters@massac.medalliesdirect.net

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Massac Memorial HospitalMetropolis, IL, CCN 141323 Hospital W-2 Managing Employee Jan 1, 2024
Massac Memorial HospitalMetropolis, IL, CCN 14Z323 Hospital W-2 Managing Employee Jan 1, 2024
Massac Memorial Medical ClinicMetropolis, IL, CCN 143478 Rural health clinic Corporate Director
W-2 Managing Employee		 Jan 1, 2025
Jan 1, 2025
Massac Memorial Medical Clinic IIMetropolis, IL, CCN 148598 Rural health clinic W-2 Managing Employee Jan 1, 2024
Massac Memorial Integrated Care ClinicMetropolis, IL, CCN 148618 Rural health clinic W-2 Managing Employee Jan 1, 2024

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 8

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.

Hospital & facility affiliations 5

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": "1245715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525910400000",
    "number": "1427286038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 CHICK ST",
            "city": "METROPOLIS",
            "state": "IL",
            "postal_code": "629602467",
            "telephone_number": "618-524-2176",
            "fax_number": "618-524-4131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 CHICK ST STE 100",
            "city": "METROPOLIS",
            "state": "IL",
            "postal_code": "629602467",
            "telephone_number": "618-638-1343",
            "fax_number": "618-638-1340"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "28 Chick St",
            "address_purpose": "LOCATION",
            "city": "Metropolis",
            "state": "IL",
            "postal_code": "629602467",
            "country_code": "US",
            "telephone_number": "618-524-2176 x2382",
            "fax_number": "618-524-4131",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1204 W 10th St",
            "address_purpose": "LOCATION",
            "city": "Metropolis",
            "state": "IL",
            "postal_code": "629602433",
            "country_code": "US",
            "telephone_number": "618-524-3572",
            "fax_number": "618-524-3496",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "JONATHAN",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-23",
        "last_updated": "2018-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "45065",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036144530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Metropolis, IL

Sources for this page

Verify at the official NPI Registry.