Individual provider Active NPI

William J Walters, D.O.

  • Psychiatry Physician
  • Grand Rapids, MI
National Provider Identifier
1699772442
Registry record updated Jan 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
5101011070 Issued in MI
Practice address
1179 E Paris Ave SE
Suite 220
Grand Rapids, MI 49546-3682
Phone
(616) 454-2004
Fax
(616) 454-0061
NPI assigned
Jul 7, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 5101011070 MI Primary

Addresses

Primary practice location

1179 E Paris Ave SE
Suite 220
Grand Rapids, MI 49546-3682

Mailing address

100 Michigan St NE
Mc845
Grand Rapids, MI 49503-2560

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20100825000856 MI Practitioner - Psychiatry 5799746715 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Pine Rest Christian Mental Health ServicesGroup PAC ID 4981506508, 354 clinicians

Practice addresses (Care Compare)

300 68TH St SE
Grand Rapids, MI 49548-6927
Phone (616) 455-5000

300 SE 68TH St
Grand Rapids, MI 49548-6927
Phone (616) 455-5000

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pine Rest Christian Mental Health Services CurrentSince Oct 1, 1996 Accepting new patients
Pine Rest Christian Mental Health Services Psychiatry CurrentSince Oct 1, 1996 Accepting new patients
Pine Rest Christian Mental Health Services Current Accepting new patients

Locations

877 Forest Hill Ave SE
Grand Rapids, MI 49546
Phone (616) 258-7507

2118 3 Mile Rd NW
Walker, MI 49544
Phone (616) 222-3720

300 68th St SE
Wyoming, MI 49548
Phone (616) 455-5000

Organizations & group practices 3

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": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326326400000",
    "number": "1699772442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "address_2": "MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1179 E PARIS AVE SE",
            "address_2": "SUITE 220",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495463682",
            "telephone_number": "616-454-2004",
            "fax_number": "616-454-0061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "WILLIAM",
        "middle_name": "J",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2012-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "5101011070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.