NPIMap

Individual provider Active NPI

Bobby Clifton Walters Jr., MD

  • Diagnostic Radiology Physician
  • Greenville, NC
National Provider Identifier
1518949924
Registry record updated Apr 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
200101294 Issued in NC
Practice address
2101 W Arlington Blvd Ste 210
Greenville, NC 27834-5758
Phone
(252) 931-7638
Fax
(252) 931-7694
NPI assigned
Nov 19, 2005
Last updated
Apr 29, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 200101294 NC Primary

Addresses

Primary practice location

2101 W Arlington Blvd Ste 210
Greenville, NC 27834-5758

Mailing address

PO Box 30750
Greenville, NC 27833-0750
Phone (252) 931-7638

Other identifiers 1

IdentifierTypeStateIssuer
5901820MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20050622001252 NC Practitioner - Diagnostic Radiology 0840235693 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Brody School of Medicine at East Carolina University, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eastern Radiologists IncGroup PAC ID 2466355383, 92 clinicians

Practice addresses (Care Compare)

2101 W Arlington Blvd
Suite 210
Greenville, NC 27834-5758
Phone (252) 752-5000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
East Carolina University CurrentSince Nov 15, 2022 Accepting new patients
Eastern Radiologists Inc Diagnostic Radiology CurrentSince Jul 1, 2005 Accepting new patients
Sentara Advanced Imaging Solutions, LLC Diagnostic Radiology CurrentSince Jan 1, 2024 Accepting new patients
East Carolina University Current Accepting new patients
Vidant Medical Group LLC Past Accepting new patients

Locations

2100 Stantonsburg Rd
Greenville, NC 27834
Phone (252) 744-3229

2101 W Arlington Blvd
Greenville, NC 27834
Phone (252) 931-7638

2101 W Arlington Blvd
#210
Greenville, NC 27834

2101 W Arlington Blvd
Ste 210
Greenville, NC 27834
Phone (252) 931-7638

402 Bowman Gray Dr
Greenville, NC 27834
Phone (252) 744-9490

600 Moye Blvd
Greenville, NC 27834
Phone (252) 744-1111

9 Doctors Park
Greenville, NC 27834

630 E 11th St
Washington, NC 27889
Phone (252) 946-2137

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1132358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651190400000",
    "number": "1518949924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30750",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278330750",
            "telephone_number": "252-931-7638",
            "fax_number": "252-931-7694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 W ARLINGTON BLVD STE 210",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278345758",
            "telephone_number": "252-931-7638",
            "fax_number": "252-931-7694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "BOBBY",
        "middle_name": "CLIFTON",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-19",
        "last_updated": "2022-04-29",
        "certification_date": "2022-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "200101294",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5901820",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, NC

Sources for this page

Verify at the official NPI Registry.