Active NPI
David A Waters, M.D.
- Pediatrics Physician
- Milwaukee, WI
National Provider Identifier
1467458810
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 28809
- Practice address
- 1032 S Cesar E Chavez Dr
Milwaukee, WI 53204-2203 - Phone
- (414) 672-1353
- Fax
- (414) 672-4265
- NPI assigned
- Jun 21, 2005
- Last updated
- Mar 7, 2023
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 28809 | WI | Primary |
Addresses
Primary practice location
1032 S Cesar E Chavez Dr
Milwaukee, WI 53204-2203
Mailing address
1032 S Cesar E Chavez Dr
Milwaukee, WI 53204-2203
Phone (414) 672-1353
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7767338 | Other | WI | AETNA |
| 004000236A | Other | WI | HUMANA |
| 468311194000 | Other | WI | BC/BS |
| 30833300 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170607000420 | WI | Order and Referring Only - Pediatric Medicine | 9335176171 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28809 | WI | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1467458810",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1032 S CESAR E CHAVEZ DR",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532042203",
"telephone_number": "414-672-1353",
"fax_number": "414-672-4265"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1032 S CESAR E CHAVEZ DR",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532042203",
"telephone_number": "414-672-1353",
"fax_number": "414-672-4265"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATERS",
"first_name": "DAVID",
"middle_name": "A",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-21",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "WI",
"license": "28809",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7767338",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HUMANA",
"identifier": "004000236A",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS",
"identifier": "468311194000",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30833300",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.