Walter David Pepple, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01023389 Issued in IN

Practice address

10327 Dawsons Creek Blvd
9 D
Fort Wayne, IN 46825-1909

Phone

(260) 424-8770

Fax

(260) 469-8774

NPI assigned

Nov 20, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• St Joseph Medical Group Inc

  • Family Medicine Physician
  • Angola, IN
  • NPI 1801851902
  NPD (past)

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405382400000",
    "number": "1578637831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10327 DAWSONS CREEK BLVD",
            "address_2": "9 D",
            "city": "FT WAYNE",
            "state": "IN",
            "postal_code": "468251909",
            "telephone_number": "260-424-8770",
            "fax_number": "260-469-8774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10327 DAWSONS CREEK BLVD",
            "address_2": "9 D",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251909",
            "telephone_number": "260-424-8770",
            "fax_number": "260-469-8774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEPPLE",
        "first_name": "WALTER",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-20",
        "last_updated": "2014-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01023389",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100103630D",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• People of Conviction
• Evan Pepple, RBT
• Shana Marie Pepple, MA, BCBA
• Stephan Edwin Pepple, M.D.
• Stephen Alan Pepple
• Jamie Lynn Peppler, FNP-C
• Jennifer N Peppler
• Mary K Pequignot, MSED, LMHC
• Melanie L Pequignot, PA
• Regina Pequignot

• Family Medicine Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2014; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.