Bradley B Waller, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

R-11492 Issued in IA

Practice address

206 N Arcade St
Maquoketa, IA 52060-2022

Phone

(563) 652-6711

Fax

(563) 652-6715

NPI assigned

May 23, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IA

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

Specialty

Family Practice

Education

Saint Louis University School of Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Maquoketa Family ClinicGroup PAC ID 1951291095, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Angels Care Home Health of Iowa Home health agency, Davenport, IA, CCN 167437
• Unitypoint at Home Home health agency, Dubuque, IA, CCN 167002
• Genesis Vna Home health agency, Bettendorf, IA, CCN 167012
• Hospice of Jackson County Hospice, Maquoketa, IA, CCN 161569
• Jackson County Regional Health Center Hospital, Maquoketa, IA, CCN 161329
• Maquoketa Care Center Nursing home, Maquoketa, IA, CCN 165579
• Jackson County Regional Health Center Nursing home, CCN 16Z329

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Hospice of Jackson County,Inc

  • Community Based Hospice Care Agency
  • Maquoketa, IA
  • NPI 1609873769

  Contracted Managing Employee, Corporate Director

  CMS ownership

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.

• Maquoketa Family Clinic

  • Family Medicine Physician
  • Maquoketa, IA
  • NPI 1407845175
  Medicare reassignment Care Compare group NPD
• Broadlawns Medical Center

  • General Acute Care Hospital
  • Des Moines, IA
  • NPI 1467447508
  Medicare reassignment NPD
• Broadlawns Medical Center

  • Pharmacy
  • Des Moines, IA
  • NPI 1013197060
  NPD

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

• E Medical Group of Iowa No 1 LLC

  • Home Health Agency
  • Davenport, IA
  • NPI 1003327446
  Care Compare affiliation
• Genesis Health System

  • Home Health Agency
  • Bettendorf, IA
  • NPI 1467404491
  Care Compare affiliation
• Hospice of Jackson County,Inc

  • Community Based Hospice Care Agency
  • Maquoketa, IA
  • NPI 1609873769
  Care Compare affiliation
• Jackson County Public Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Maquoketa, IA
  • NPI 1326002643

  Nursing home

  Care Compare affiliation
• Jackson County Public Hospital

  • Critical Access Hospital
  • Maquoketa, IA
  • NPI 1912960758
  Care Compare affiliation
• Maquoketa Opco LLC

  • Skilled Nursing Facility
  • Maquoketa, IA
  • NPI 1932807229

  Nursing home

  Care Compare affiliation
• The Finley Hospital

  • Home Health Agency
  • Dubuque, IA
  • NPI 1720187560
  Care Compare affiliation

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

{
    "created_epoch": "1558569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709683200000",
    "number": "1609433796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 N ARCADE ST",
            "city": "MAQUOKETA",
            "state": "IA",
            "postal_code": "520602022",
            "telephone_number": "563-652-6711",
            "fax_number": "563-652-6715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 N ARCADE ST",
            "city": "MAQUOKETA",
            "state": "IA",
            "postal_code": "520602022",
            "telephone_number": "563-652-6711",
            "fax_number": "563-652-6715"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1801 Hickman Rd",
            "address_purpose": "LOCATION",
            "city": "Des Moines",
            "state": "IA",
            "postal_code": "503141505",
            "country_code": "US",
            "telephone_number": "515-282-5640",
            "fax_number": "515-282-2332",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLER",
        "first_name": "BRADLEY",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-23",
        "last_updated": "2024-03-06",
        "certification_date": "2024-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "47781",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "R-11492",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Farah Marie Towfic, PHARMD
• Clifford James Trilk, CRNA
• Megan Elizabeth Vance
• Matthew Lawrence Waack, D.C.
• Wayne L Wagoner, DPM
• Roger R Waller, MD
• Walmart Inc.
• Wayne L. Wagoner, DPM, PC
• Ashlyn Elizabeth Wernimont, LMSW
• Valerie Wersching

• Family Medicine Physician in Maquoketa, IA
• Providers in Maquoketa, IA by specialty
• Family Medicine Physician in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; 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.