Individual provider Active NPI

Jade Nicole Walter, DO

  • Pediatrics Physician
  • Gainesville, FL
National Provider Identifier
1649851692
Registry record updated Aug 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
OS21244 Issued in FL
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

Updated by the provider on Aug 28, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
123627500MedicaidFL

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240911004464 FL Practitioner - Pediatric Medicine 2365982725 Reassigns benefits to 1 organization

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
Florida Clinical Practice Association IncGroup PAC ID 0345146254, 1,886 clinicians

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

OrganizationSpecialtyStatusNew patients
Florida Clinical Practice Association Inc CurrentSince Aug 16, 2024 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Aug 16, 2024 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

  • Direct secure messaging: 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.

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

Verify at the official NPI Registry.