NPIMap

Individual provider Active NPI

Franklin W Waller Jr., MD

  • Family Medicine Physician
  • Columbia, MS
National Provider Identifier
1497864607
Registry record updated Aug 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
15125 Issued in MS
Practice address
502 Broad St
Columbia, MS 39429-3037
Phone
(601) 736-8282
Fax
(601) 736-8333
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 15125 MS Primary

Addresses

Primary practice location

502 Broad St
Columbia, MS 39429-3037

Mailing address

415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 736-8282

Other identifiers 4

IdentifierTypeStateIssuer
080096788OtherMSRAILROAD MEDICARE
640507572AYOtherMSAMERICAN ADMIN GROUP
00117443MedicaidMS
1582301MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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
I20080129000359 MS Practitioner - Family Practice 0446332563 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Arkansas College of Medicine, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hattiesburg Clinic PAGroup PAC ID 5193706794, 525 clinicians

Practice addresses (Care Compare)

415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 264-6000

Hospital & facility affiliations

  • Enhabit Home Health & Hospice Home health agency, Hattiesburg, MS, CCN 257091
  • St Luke Home Health Services Home health agency, McComb, MS, CCN 257124
  • Forrest General Home Care of Marion General Home health agency, Columbia, MS, CCN 257089
  • Marion General Hospital Hospital, Columbia, MS, CCN 250085

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Hattiesburg Clinic, PA CurrentSince Dec 5, 1996 Accepting new patients
Hattiesburg Clinic PA CurrentSince Dec 5, 1996 Accepting new patients
Public Hospital District No.1 of Mason County Washington Past Accepting new patients
Public Hospital District No.1 of Mason County Washington Family Medicine Past Accepting new patients
Hattiesburg Clinic, PA Past Accepting new patients

Locations

502 Broad St
Columbia, MS 39429
Phone (601) 736-8282

415 S 28th Ave
Hattiesburg, MS 39401
Phone (601) 261-3606

105 Thornhill Dr
Hattiesburg, MS 39402
Phone (601) 261-3737

Interoperability endpoints

  • Direct secure messaging: dwaller2391@directpatientrecord.com

Organizations & group practices 5

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.

Hospital & facility affiliations 4

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": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471910400000",
    "number": "1497864607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017246",
            "telephone_number": "601-736-8282",
            "fax_number": "601-579-5240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 BROAD ST",
            "city": "COLUMBIA",
            "state": "MS",
            "postal_code": "394293037",
            "telephone_number": "601-736-8282",
            "fax_number": "601-736-8333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "FRANKLIN",
        "middle_name": "W",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2016-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "15125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080096788",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN ADMIN GROUP",
            "identifier": "640507572AY",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00117443",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1582301",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MS

Sources for this page

Verify at the official NPI Registry.