Heather Elizabeth Waters, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

21796 Issued in MS

Practice address

596 W 11TH Ave
Lumberton, MS 39455-2350

Phone

(601) 596-4215

Fax

(601) 796-9437

NPI assigned

Jun 23, 2010

Last updated

Nov 15, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Heather Elizabeth White Aultman Former name

Medicare fee-for-service enrollment

Enrolled in FL, MS2 enrollments

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 2

Specialty

Family Practice

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southeast Mississippi Rural Health Initiative, Inc.Group PAC ID 2466342605, 38 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Pearl River County Hospital Hospital, Poplarville, MS, CCN 251333

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: hwaters142701@directpatientrecord.com

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.

• Sumrall Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Sumrall, MS
  • NPI 1184694036
  Medicare reassignment Care Compare group NPD
• Santa Rosa Hma Physician Management, LLC

  • Family Medicine Physician
  • Milton, FL
  • NPI 1447365366
  Medicare reassignment NPD
• Hattiesburg Community Dental Center

  • Federally Qualified Health Center (FQHC)
  • Hattiesburg, MS
  • NPI 1366468266
  NPD
• Southeast Mississippi Rural Health Initiative, Inc.

  dba Hattiesburg Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Hattiesburg, MS
  • NPI 1538136940
  NPD
• Lamar County School Clinic

  • Federally Qualified Health Center (FQHC)
  • Purvis, MS
  • NPI 1679147847
  NPD (past)
• Lumberton Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Lumberton, MS
  • NPI 1164499174
  NPD (past)

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

• Forrest County General Hospital

  dba Pearl River County Hospital & Nursing Home

  • Critical Access Hospital
  • Poplarville, MS
  • NPI 1760789903
  Care Compare affiliation

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

{
    "created_epoch": "1277251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731628800000",
    "number": "1700197977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1729",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394031729",
            "telephone_number": "601-545-8700",
            "fax_number": "601-255-2645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "596 W 11TH AVE",
            "city": "LUMBERTON",
            "state": "MS",
            "postal_code": "394552350",
            "telephone_number": "601-596-4215",
            "fax_number": "601-796-9437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERS",
        "first_name": "HEATHER",
        "middle_name": "ELIZABETH",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-23",
        "last_updated": "2024-11-15",
        "certification_date": "2024-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "21796",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MS MEDICAL LICENSE",
            "identifier": "21796",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008504826",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEATHER",
            "last_name": "AULTMAN",
            "middle_name": "ELIZABETH WHITE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Southeast Mississippi Rural Health Initiative, Inc (Lumberton Middle School)
• St. Luke Missionary Hospice, LLC
• Patricia A Thompson, FNP-BC
• Robbie M Throop
• William Henry Vann Jr., D.D.S., M.A.E.D.
• Carla Whitfield, FNP-BC
• Mark S Wood, M.D.
• Brittney Michelle Young, COTA

• Family Medicine Physician in Lumberton, MS
• Providers in Lumberton, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 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.

Verify at the official NPI Registry.