NPIMap

Individual provider Active NPI

Cornelius Todd Walter, MD

  • Family Medicine Physician
  • Landrum, SC
National Provider Identifier
1619948379
Registry record updated Jan 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
17420 Issued in SC
Practice address
133 N Howard Ave
Landrum, SC 29356
Phone
(864) 560-9507
NPI assigned
Jan 31, 2006
Last updated
Jan 13, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 9601513 NC
Family Medicine Physician 207Q00000X 17420 SC Primary

Addresses

Primary practice location

133 N Howard Ave
Landrum, SC 29356

Mailing address

PO Box 743070
Atlanta, GA 30374-3070
Phone (864) 560-4304

Other identifiers 8

IdentifierTypeStateIssuer
890665GMedicaidNC
5850260OtherSCAETNA
66392OtherSCMEDCOST
080120336OtherSCRAIL ROAD MEDICARE
2279674COtherNCMEDICARE PIN
F876975121OtherSCMEDICARE PIN
174206MedicaidSC
P00721817OtherNCRR MEDICARE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cwalter8445@direct-srhs.et0939.epichosted.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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
I20100210000018 SC Practitioner - Family Practice 4587749627 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of South Carolina School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Spartanburg Medical CenterGroup PAC ID 3072425297, shared by 17 NPIs, 1,060 clinicians

Practice addresses (Care Compare)

133 N Howard Ave
Landrum, SC 29356-1507
Phone (864) 457-3838

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.7 of 100Reported as apm
Quality
89.4
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions12
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9601513NCMDFamily Medicine Physician
17420SCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Spartanburg Medical Center Family Medicine CurrentSince Jul 22, 1996 Accepting new patients
Spartanburg Medical Center Current Accepting new patients
Spartanburg Medical Center Current Accepting new patients
Spartanburg Medical Center Family Medicine CurrentSince Feb 1, 2025 Accepting new patients
Emcare Physician Providers, Inc. Past Accepting new patients
Spartanburg Medical Center Past Accepting new patients
Polk Emergency Physicians LLC Past Accepting new patients

Locations

617 Laurel Lake Dr
Columbus, NC 28722
Phone (828) 894-3000

133 N Howard Ave
Landrum, SC 29356
Phone (864) 457-3838

101 E Wood St
Spartanburg, SC 29303
Phone (864) 560-1915

101 E Wood St
Ste 300
Spartanburg, SC 29303
Phone (864) 560-6554

Interoperability endpoints

  • Direct secure messaging: cwalter8445@direct-srhs.et0939.epichosted.com

Organizations & group practices 7

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 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1138665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610496000000",
    "number": "1619948379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 743070",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303743070",
            "telephone_number": "864-560-4304",
            "fax_number": "864-560-4413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 N HOWARD AVE",
            "city": "LANDRUM",
            "state": "SC",
            "postal_code": "29356",
            "telephone_number": "864-560-9507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTER",
        "first_name": "CORNELIUS",
        "middle_name": "TODD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-31",
        "last_updated": "2021-01-13",
        "certification_date": "2021-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "9601513",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "17420",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890665G",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5850260",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "66392",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "080120336",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "2279674C",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "F876975121",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "174206",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00721817",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cwalter8445@direct-srhs.et0939.epichosted.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "cwalter8445@direct-srhs.et0939.epichosted.com",
            "address_1": "133 N Howard Ave",
            "city": "Landrum",
            "state": "SC",
            "country_code": "US",
            "postal_code": "29356",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Landrum, SC

Sources for this page

Verify at the official NPI Registry.