NPIMap

Individual provider Active NPI

Michael James Walls, M.D.

  • Specialist
  • Conroe, TX
National Provider Identifier
1679579791
Registry record updated Oct 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
J6047 Issued in TX
Practice address
4015 I 45 N Ste 310
Conroe, TX 77304-5077
Phone
(936) 520-8983
Fax
(936) 463-6508
NPI assigned
Jun 23, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X J6047 TX
Specialist 174400000X J6047 TX Primary

Addresses

Primary practice location

4015 I 45 N Ste 310
Conroe, TX 77304-5077

Mailing address

PO Box 95533
Grapevine, TX 76099-9703
Phone (936) 520-8983

Other identifiers 1

IdentifierTypeStateIssuer
102913404MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20170329000893 TX Practitioner - Internal MedicinePractitioner - NephrologyPractitioner - Hospitalist 5597804963 Practice locations: Conroe, TX; The Woodlands, TX; Shenandoah, TX

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Hospitalist, Nephrology
Education
University of Texas Medical School at Houston, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1500 Grand Lake Dr
Conroe, TX 77304-2891
Phone (936) 520-8983

4015 I 45 N
Conroe, TX 77304-5076
Phone (936) 520-8983

504 Medical Ctr Blvd
Conroe, TX 77304-2808
Phone (936) 520-8983

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
J6047TXMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kidney Specialists of the Woodlands and Conroe Current Accepting new patients
Cardiovascular Care Providers, Inc. Specialist Past Accepting new patients
CHG Hospital Conroe, LLC Past Accepting new patients
Kadden Dialysis, LLC PastSince Dec 8, 2015 Accepting new patients

Locations

4015 Interstate 45 N
Ste 220
Conroe, TX 77304
Phone (936) 441-1122

4015 I 45 N
Ste 310
Conroe, TX 77304
Phone (346) 646-3500

Organizations & group practices 4

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.

Hospital & facility affiliations 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1119484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730073600000",
    "number": "1679579791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 95533",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760999703",
            "telephone_number": "936-520-8983",
            "fax_number": "936-463-6508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4015 I 45 N STE 310",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773045077",
            "telephone_number": "936-520-8983",
            "fax_number": "936-463-6508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLS",
        "first_name": "MICHAEL",
        "middle_name": "JAMES",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-23",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "TX",
            "license": "J6047",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TX",
            "license": "J6047",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102913404",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Conroe, TX

Sources for this page

Verify at the official NPI Registry.