Active NPI
Jeremy Peter Waletzky, M.D.
- Psychiatry Physician
- Washington, DC
National Provider Identifier
1609095082
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- MD041283
- Practice address
- 633 E St SE
Washington, DC 20003-2991 - Phone
- (202) 486-7174
- Fax
- (877) 792-0172
- NPI assigned
- Apr 24, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | MD041283 | DC | Primary |
Addresses
Primary practice location
633 E St SE
Washington, DC 20003-2991
Mailing address
633 E St SE
Washington, DC 20003-2991
Phone (202) 486-7174
Other practice location 1
2 Wisconsin Cir
Suite 920
Chevy Chase, MD 20815-7003
Phone (301) 652-9450
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Mar 1, 2016 through Mar 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD041283 | DC | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599609600000",
"number": "1609095082",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "633 E ST SE",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200032991",
"telephone_number": "202-486-7174",
"fax_number": "877-792-0172"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "633 E ST SE",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200032991",
"telephone_number": "202-486-7174",
"fax_number": "877-792-0172"
}
],
"practiceLocations": [
{
"address_1": "2 Wisconsin Cir",
"address_2": "Suite 920",
"address_purpose": "LOCATION",
"city": "Chevy Chase",
"state": "MD",
"postal_code": "208157003",
"country_code": "US",
"telephone_number": "301-652-9450",
"fax_number": "301-652-9051",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WALETZKY",
"first_name": "JEREMY",
"middle_name": "PETER",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-24",
"last_updated": "2020-09-09",
"certification_date": "2020-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "DC",
"license": "MD041283",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2020; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.