NPIMap

Individual provider Active NPI

John Robert Walli, NURSE PRACTIONER

  • Family Nurse Practitioner
  • Biloxi, MS
National Provider Identifier
1508138843
Registry record updated Nov 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R850026 Issued in MS
Practice address
16443 Delia Dr
Biloxi, MS 39532-9411
Phone
(228) 861-8505
NPI assigned
Feb 2, 2012
Last updated
Nov 30, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 30, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R850026 MS Primary

Addresses

Primary practice location

16443 Delia Dr
Biloxi, MS 39532-9411

Mailing address

16443 Delia Dr
Biloxi, MS 39532-9411
Phone (228) 860-5164

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
I20120917000388 MS Practitioner - Nurse Practitioner 0749438711 Practice locations: Biloxi, MS; Gulfport, MS

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

150 Reynoir St
Biloxi, MS 39530-4130
Phone (228) 432-1571

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R850026MSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
John Walli NPC CurrentSince Apr 6, 2013 Accepting new patients
Terry C. Smith, M.D., PA Past Accepting new patients
Garden Park Physician Group-Specialty Care, LLC Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 3

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 60

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1328140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575072000000",
    "number": "1508138843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16443 DELIA DR",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395329411",
            "telephone_number": "228-860-5164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16443 DELIA DR",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395329411",
            "telephone_number": "228-861-8505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLI",
        "first_name": "JOHN",
        "middle_name": "ROBERT",
        "credential": "NURSE PRACTIONER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-02-02",
        "last_updated": "2019-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R850026",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Biloxi, MS

Sources for this page

Verify at the official NPI Registry.