Active NPI
Jade Nicole Walter, DO
- Pediatrics Physician
- Gainesville, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- OS21244
- Practice address
- 1600 SW Archer Rd
Gainesville, FL 32610-7226 - Phone
- (352) 627-9350
- NPI assigned
- Apr 20, 2021
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | OS21244 | FL | Primary |
Addresses
Primary practice location
1600 SW Archer Rd
Gainesville, FL 32610-7226
Mailing address
4740 NW 39TH PL Ste B
Gainesville, FL 32606-7226
Phone (301) 742-2031
Other practice location 1
901 18th St E
Tifton, GA 31794-3648
Phone (301) 742-2031
Other practice location 2
4740 NW 39th Pl Ste B
Gainesville, FL 32606-7226
Phone (301) 742-2031
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 123627500 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Pediatric Medicine
- Education
- Nova Southeastern College of Osteo Medicine, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1699 SW 16TH Ave
Gainesville, FL 32608-1158
2001 SW 13TH St
Gainesville, FL 32608-1532
Phone (352) 265-8990
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Florida Clinical Practice Association Inc | Current | Accepting new patients | |
| Florida Clinical Practice Association Inc | Current | Accepting new patients |
Locations
2001 SW 13th St
Gainesville, FL 32608
Phone (352) 265-8990
4740 NW 39th Pl
Ste B
Gainesville, FL 32606
Phone (301) 742-2031
1600 SW Archer Rd
Gainesville, FL 32610
Phone (352) 265-0077
Interoperability endpoints
- jwalter729714@direct.shands.ufl.edu
Organizations & group practices 2
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.
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- NPI 1609529478
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1618876800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724803200000",
"number": "1649851692",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4740 NW 39TH PL STE B",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326067226",
"telephone_number": "301-742-2031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 SW ARCHER RD",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326107226",
"telephone_number": "352-627-9350"
}
],
"practiceLocations": [
{
"address_1": "901 18th St E",
"address_purpose": "LOCATION",
"city": "Tifton",
"state": "GA",
"postal_code": "317943648",
"country_code": "US",
"telephone_number": "301-742-2031",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4740 NW 39th Pl Ste B",
"address_purpose": "LOCATION",
"city": "Gainesville",
"state": "FL",
"postal_code": "326067226",
"country_code": "US",
"telephone_number": "301-742-2031",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WALTER",
"first_name": "JADE",
"middle_name": "NICOLE",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-20",
"last_updated": "2024-08-28",
"certification_date": "2024-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "FL",
"license": "OS21244",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "123627500",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Gainesville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2024; 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.
- 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.