Individual provider Active NPI

Jessica Lynn Walters, M.D.

  • Pediatrics Physician
  • Cincinnati, OH
National Provider Identifier
1487073540
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
35.131006 Issued in OH
Practice address
3430 Burnet Ave
Cincinnati, OH 45229-2833
Phone
(513) 636-7722
Fax
(513) 636-3737
NPI assigned
Apr 15, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Pediatrics Physician 208000000X 35.131006 OH Primary

Addresses

Primary practice location

3430 Burnet Ave
Cincinnati, OH 45229-2833

Mailing address

3430 Burnet Ave.
ML 5026
Cincinnati, OH 45229-3026
Phone (513) 636-7722

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20170710001793 OH Practitioner - Pediatric Medicine 1254554793 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Hospital Medical Center Pediatrics CurrentSince Jul 24, 2017 Accepting new patients
Montgomery Pediatrics Incorporated Past Accepting new patients

Locations

3341 Solutions Ctr
Chicago, IL 60677

3430 Burnet Ave
Ofc
Cincinnati, OH 45229
Phone (513) 636-7722

3333 Burnet Ave
#5021
Cincinnati, OH 45229
Phone (513) 636-4225

3333 Burnet Ave
Cincinnati, OH 45229
Phone (513) 636-4200

3430 Burnet Ave
#5026
Cincinnati, OH 45229
Phone (513) 517-1253

3430 Burnet Ave
Cincinnati, OH 45229
Phone (513) 636-4651

3050 Mack Rd
Fairfield, OH 45014
Phone (513) 557-7718

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8872/brand/1/csg/1/fhir/r4

Organizations & group practices 2

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": "1397520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1487073540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3430 BURNET AVE.",
            "address_2": "ML 5026",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452293026",
            "telephone_number": "513-636-7722",
            "fax_number": "513-636-3737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3430 BURNET AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452292833",
            "telephone_number": "513-636-7722",
            "fax_number": "513-636-3737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "JESSICA",
        "middle_name": "LYNN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-15",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35.131006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

Verify at the official NPI Registry.