Adam Waller, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

209021745 Issued in IL

Practice address

502 W Saint Louis St Ste 4
West Frankfort, IL 62896-1968

Phone

(618) 937-3400

Fax

(618) 997-9324

NPI assigned

Aug 4, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 3

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Logan Primary Care Service Corp.Group PAC ID 8628967064, 33 clinicians

Southern Illinois Medical Services NFPGroup PAC ID 3678677390, 331 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Hospice of Southern Illinois, Inc Hospice, Belleville, IL, CCN 141504
• Herrin Hospital Hospital, Herrin, IL, CCN 140011
• Memorial Hospital of Carbondale Hospital, Carbondale, IL, CCN 140164
• Franklin Hospital Hospital, Benton, IL, CCN 141321

Merit-based Incentive Payment System (MIPS)

Final score

82 of 100Reported as group

Quality

55.9

Promoting interoperability

100

Improvement activities

40

Cost

72.01

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: awaller7137@sih.direct-ci.com

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.

• Southern Illinois Medical Services, NFP

  • Internal Medicine Physician
  • Carbondale, IL
  • NPI 1770656837
  Medicare reassignment Care Compare group NPD
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  IL, Nurse Practitioner

  Medicare reassignment NPD

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

• Franklin Hospital District

  • Critical Access Hospital
  • Benton, IL
  • NPI 1699778951
  Care Compare affiliation
• Hospice of Southern Illinois, Inc.

  • Community Based Hospice Care Agency
  • Belleville, IL
  • NPI 1720081805
  Care Compare affiliation
• Southern Illinois Hospital Services

  • General Acute Care Hospital
  • Carbondale, IL
  • NPI 1093801797
  Care Compare affiliation
• Southern Illinois Hospital Services

  • General Acute Care Hospital
  • Herrin, IL
  • NPI 1528158573
  Care Compare affiliation

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

{
    "created_epoch": "1596499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653264000000",
    "number": "1508476615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3988",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629023988",
            "telephone_number": "618-937-3400",
            "fax_number": "618-997-9324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 W SAINT LOUIS ST STE 4",
            "city": "WEST FRANKFORT",
            "state": "IL",
            "postal_code": "628961968",
            "telephone_number": "618-937-3400",
            "fax_number": "618-997-9324"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2601 W Main St",
            "address_purpose": "LOCATION",
            "city": "Carbondale",
            "state": "IL",
            "postal_code": "629011031",
            "country_code": "US",
            "telephone_number": "618-549-5361",
            "fax_number": "618-351-4878",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "405 Rushing Dr",
            "address_purpose": "LOCATION",
            "city": "Herrin",
            "state": "IL",
            "postal_code": "629483730",
            "country_code": "US",
            "telephone_number": "618-993-3300",
            "fax_number": "618-993-0262",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLER",
        "first_name": "ADAM",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-08-04",
        "last_updated": "2022-05-23",
        "certification_date": "2022-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209021745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "awaller7137@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "502 W Saint Louis St Ste 4",
            "city": "West Frankfort",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628961968",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "awaller7137@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "2601 W Main St",
            "city": "Carbondale",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629011031",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "awaller7137@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "405 Rushing Dr",
            "city": "Herrin",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629483730",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Carol A Valladares, MSW, QMHP
• Christy Vanzant
• Brittany Vaughn, LCSW
• Kayla Diane Wagner, M.S., BCBA
• Gwendolyn Walker
• Cacie Walton
• Gloria Wargel
• Debra Watkins
• Kristen Watkins, DC
• Jacob Weatherford, LCPC

• Nurse Practitioner in West Frankfort, IL
• Providers in West Frankfort, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.